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Barboriak, Daniel P.

Overview:

(1) MR Imaging in Neuro-oncology. (2) MR Perfusion Imaging for quantitation of blood volume and permeability. (3) MR Diffusion Imaging. (4) Image Processing for Registration and Segmentation. (5) Pediatric Neuroradiology.

Positions:

Professor of Radiology

Radiology, Neuroradiology
School of Medicine

Professor in Pediatrics

Pediatrics
School of Medicine

Professor in Neurosurgery

Neurosurgery
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1986

M.D. — Harvard University

Grants:

Quantitative Staging and Therapeutic Response in IDH-1 Mutated Glioblastomas

Administered By
Radiology
AwardedBy
National Institutes of Health
Role
Investigator
Start Date
March 01, 2017
End Date
February 28, 2019

NCI National Clinical Trials Network U10 (Year 4)

Administered By
Duke Cancer Institute
AwardedBy
National Institutes of Health
Role
Co-Principal Investigator
Start Date
April 14, 2014
End Date
February 28, 2019

EGFRvIII-targeted Bispecific T cell Engagers for brain tumors

Administered By
Neurosurgery
AwardedBy
National Institutes of Health
Role
Investigator
Start Date
September 30, 2013
End Date
May 31, 2018

Aggregated Measures of Agreement for QIB Validation: An Open Source Toolkit

Administered By
Radiology, Neuroradiology
AwardedBy
Radiological Society of North America
Role
Principal Investigator
Start Date
September 30, 2015
End Date
September 29, 2017

Ph 1/2 trial BMX-001

Administered By
Neurosurgery, Neuro-Oncology
AwardedBy
BioMimetix JV LLC
Role
Co Investigator
Start Date
September 18, 2015
End Date
August 31, 2017

Therapeutic Vaccine Targeting CMV Antigens in Glioblastoma

Administered By
Neurosurgery
AwardedBy
Annias Immunotherapeutics, Inc.
Role
Investigator
Start Date
August 10, 2015
End Date
July 31, 2017

ACRIN Chair Agreement (2016)

Administered By
Radiology
AwardedBy
American College of Radiology Imaging Network
Role
Principal Investigator
Start Date
March 01, 2015
End Date
February 28, 2017

QIBA - Digital Reference Object for Profile DCE-MRI Analysis Software Verification 2

Administered By
Radiology, Neuroradiology
AwardedBy
Radiological Society of North America
Role
Principal Investigator
Start Date
September 30, 2014
End Date
September 29, 2015

Subcontract for ECOG-ACRIN NCORP

Administered By
Radiology, Neuroradiology
AwardedBy
American College of Radiology Imaging Network
Role
Principal Investigator
Start Date
September 01, 2014
End Date
May 31, 2015

ACRIN Advanced MRI Imaging Core Lab Services Agreement

Administered By
Radiology
AwardedBy
American College of Radiology Imaging Network
Role
Principal Investigator
Start Date
April 29, 2014
End Date
February 28, 2015

ACRIN Chair Agreement

Administered By
Radiology
AwardedBy
American College of Radiology Imaging Network
Role
Principal Investigator
Start Date
April 29, 2014
End Date
February 28, 2015

ACRIN Advanced MRI Imaging Core Lab Services Agreement - 6684, & 6677, 6686, 6689

Administered By
Radiology
AwardedBy
American College of Radiology Imaging Network
Role
Principal Investigator
Start Date
January 01, 2013
End Date
February 28, 2014

ACRIN Chair Agreement

Administered By
Radiology
AwardedBy
American College of Radiology Imaging Network
Role
Principal Investigator
Start Date
January 01, 2013
End Date
December 31, 2013

ACRIN Advanced MRI Imaging Core Lab Services Agreement - 6684, & 6677, 6686, 6689

Administered By
Radiology
AwardedBy
American College of Radiology Imaging Network
Role
Principal Investigator
Start Date
January 01, 2012
End Date
December 31, 2013
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Publications:

ACRIN 6684: Assessment of Tumor Hypoxia in Newly Diagnosed Glioblastoma Using 18F-FMISO PET and MRI.

Structural and functional alterations in tumor vasculature are thought to contribute to tumor hypoxia which is a primary driver of malignancy through its negative impact on the efficacy of radiation, immune surveillance, apoptosis, genomic stability, and accelerated angiogenesis. We performed a prospective, multicenter study to test the hypothesis that abnormal tumor vasculature and hypoxia, as measured with MRI and PET, will negatively impact survival in patients with newly diagnosed glioblastoma.Prior to the start of chemoradiation, patients with glioblastoma underwent MRI scans that included dynamic contrast enhanced and dynamic susceptibility contrast perfusion sequences to quantitate tumor cerebral blood volume/flow (CBV/CBF) and vascular permeability (ktrans) as well as 18F-Fluoromisonidazole (18F-FMISO) PET to quantitate tumor hypoxia. ROC analysis and Cox regression models were used to determine the association of imaging variables with progression-free and overall survival.Fifty patients were enrolled of which 42 had evaluable imaging data. Higher pretreatment 18F-FMISO SUVpeak (P = 0.048), mean ktrans (P = 0.024), and median ktrans (P = 0.045) were significantly associated with shorter overall survival. Higher pretreatment median ktrans (P = 0.021), normalized RCBV (P = 0.0096), and nCBF (P = 0.038) were significantly associated with shorter progression-free survival. SUVpeak [AUC = 0.75; 95% confidence interval (CI), 0.59-0.91], nRCBV (AUC = 0.72; 95% CI, 0.56-0.89), and nCBF (AUC = 0.72; 95% CI, 0.56-0.89) were predictive of survival at 1 year.Increased tumor perfusion, vascular volume, vascular permeability, and hypoxia are negative prognostic markers in newly diagnosed patients with gioblastoma, and these important physiologic markers can be measured safely and reliably using MRI and 18F-FMISO PET. Clin Cancer Res; 22(20); 5079-86. ©2016 AACR.

Authors
Gerstner, ER; Zhang, Z; Fink, JR; Muzi, M; Hanna, L; Greco, E; Prah, M; Schmainda, KM; Mintz, A; Kostakoglu, L; Eikman, EA; Ellingson, BM; Ratai, E-M; Sorensen, AG; Barboriak, DP; Mankoff, DA
MLA Citation
Gerstner, ER, Zhang, Z, Fink, JR, Muzi, M, Hanna, L, Greco, E, Prah, M, Schmainda, KM, Mintz, A, Kostakoglu, L, Eikman, EA, Ellingson, BM, Ratai, E-M, Sorensen, AG, Barboriak, DP, and Mankoff, DA. "ACRIN 6684: Assessment of Tumor Hypoxia in Newly Diagnosed Glioblastoma Using 18F-FMISO PET and MRI." Clinical cancer research : an official journal of the American Association for Cancer Research 22.20 (October 2016): 5079-5086.
PMID
27185374
Source
epmc
Published In
Clinical cancer research : an official journal of the American Association for Cancer Research
Volume
22
Issue
20
Publish Date
2016
Start Page
5079
End Page
5086
DOI
10.1158/1078-0432.ccr-15-2529

Statistical Issues in Testing Conformance with the Quantitative Imaging Biomarker Alliance (QIBA) Profile Claims.

A major initiative of the Quantitative Imaging Biomarker Alliance is to develop standards-based documents called "Profiles," which describe one or more technical performance claims for a given imaging modality. The term "actor" denotes any entity (device, software, or person) whose performance must meet certain specifications for the claim to be met. The objective of this paper is to present the statistical issues in testing actors' conformance with the specifications. In particular, we present the general rationale and interpretation of the claims, the minimum requirements for testing whether an actor achieves the performance requirements, the study designs used for testing conformity, and the statistical analysis plan. We use three examples to illustrate the process: apparent diffusion coefficient in solid tumors measured by MRI, change in Perc 15 as a biomarker for the progression of emphysema, and percent change in solid tumor volume by computed tomography as a biomarker for lung cancer progression.

Authors
Obuchowski, NA; Buckler, A; Kinahan, P; Chen-Mayer, H; Petrick, N; Barboriak, DP; Bullen, J; Barnhart, H; Sullivan, DC
MLA Citation
Obuchowski, NA, Buckler, A, Kinahan, P, Chen-Mayer, H, Petrick, N, Barboriak, DP, Bullen, J, Barnhart, H, and Sullivan, DC. "Statistical Issues in Testing Conformance with the Quantitative Imaging Biomarker Alliance (QIBA) Profile Claims." Academic radiology 23.4 (April 2016): 496-506.
PMID
26898527
Source
epmc
Published In
Academic Radiology
Volume
23
Issue
4
Publish Date
2016
Start Page
496
End Page
506
DOI
10.1016/j.acra.2015.12.020

Metrology Standards for Quantitative Imaging Biomarkers.

Although investigators in the imaging community have been active in developing and evaluating quantitative imaging biomarkers (QIBs), the development and implementation of QIBs have been hampered by the inconsistent or incorrect use of terminology or methods for technical performance and statistical concepts. Technical performance is an assessment of how a test performs in reference objects or subjects under controlled conditions. In this article, some of the relevant statistical concepts are reviewed, methods that can be used for evaluating and comparing QIBs are described, and some of the technical performance issues related to imaging biomarkers are discussed. More consistent and correct use of terminology and study design principles will improve clinical research, advance regulatory science, and foster better care for patients who undergo imaging studies.

Authors
Sullivan, DC; Obuchowski, NA; Kessler, LG; Raunig, DL; Gatsonis, C; Huang, EP; Kondratovich, M; McShane, LM; Reeves, AP; Barboriak, DP; Guimaraes, AR; Wahl, RL
MLA Citation
Sullivan, DC, Obuchowski, NA, Kessler, LG, Raunig, DL, Gatsonis, C, Huang, EP, Kondratovich, M, McShane, LM, Reeves, AP, Barboriak, DP, Guimaraes, AR, and Wahl, RL. "Metrology Standards for Quantitative Imaging Biomarkers." Radiology 277.3 (December 2015): 813-825.
PMID
26267831
Source
epmc
Published In
Radiology
Volume
277
Issue
3
Publish Date
2015
Start Page
813
End Page
825
DOI
10.1148/radiol.2015142202

Dynamic susceptibility contrast MRI measures of relative cerebral blood volume continue to show promise as an early response marker in the setting of bevacizumab treatment.

Authors
Boxerman, JL; Schmainda, KM; Zhang, Z; Barboriak, DP
MLA Citation
Boxerman, JL, Schmainda, KM, Zhang, Z, and Barboriak, DP. "Dynamic susceptibility contrast MRI measures of relative cerebral blood volume continue to show promise as an early response marker in the setting of bevacizumab treatment." Neuro-oncology 17.11 (November 2015): 1538-1539. (Letter)
PMID
26361983
Source
epmc
Published In
Neuro-Oncology
Volume
17
Issue
11
Publish Date
2015
Start Page
1538
End Page
1539
DOI
10.1093/neuonc/nov163

Standardized Brain Tumor Imaging Protocol for Clinical Trials.

Authors
Goldmacher, GV; Ellingson, BM; Boxerman, J; Barboriak, D; Pope, WB; Gilbert, M
MLA Citation
Goldmacher, GV, Ellingson, BM, Boxerman, J, Barboriak, D, Pope, WB, and Gilbert, M. "Standardized Brain Tumor Imaging Protocol for Clinical Trials." AJNR. American journal of neuroradiology 36.10 (October 2015): E65-E66.
PMID
26359146
Source
epmc
Published In
American Journal of Neuroradiology
Volume
36
Issue
10
Publish Date
2015
Start Page
E65
End Page
E66
DOI
10.3174/ajnr.a4544

Repeatability of Standardized and Normalized Relative CBV in Patients with Newly Diagnosed Glioblastoma.

For more widespread clinical use advanced imaging methods such as relative cerebral blood volume must be both accurate and repeatable. The aim of this study was to determine the repeatability of relative CBV measurements in newly diagnosed glioblastoma multiforme by using several of the most commonly published estimation techniques.The relative CBV estimates were calculated from dynamic susceptibility contrast MR imaging in double-baseline examinations for 33 patients with treatment-naïve and pathologically proved glioblastoma multiforme (men = 20; mean age = 55 years). Normalized and standardized relative CBV were calculated by using 6 common postprocessing methods. The repeatability of both normalized and standardized relative CBV, in both tumor and contralateral brain, was examined for each method with metrics of repeatability, including the repeatability coefficient and within-subject coefficient of variation. The minimum sample size required to detect a parameter change of 10% or 20% was also determined for both normalized relative CBV and standardized relative CBV for each estimation method.When ordered by the repeatability coefficient, methods using postprocessing leakage correction and ΔR2*(t) techniques offered superior repeatability. Across processing techniques, the standardized relative CBV repeatability in normal-appearing brain was comparable with that in tumor (P = .31), yet inferior in tumor for normalized relative CBV (P = .03). On the basis of the within-subject coefficient of variation, tumor standardized relative CBV estimates were less variable (13%-20%) than normalized relative CBV estimates (24%-67%). The minimum number of participants needed to detect a change of 10% or 20% is 118-643 or 30-161 for normalized relative CBV and 109-215 or 28-54 for standardized relative CBV.The ΔR2* estimation methods that incorporate leakage correction offer the best repeatability for relative CBV, with standardized relative CBV being less variable and requiring fewer participants to detect a change compared with normalized relative CBV.

Authors
Prah, MA; Stufflebeam, SM; Paulson, ES; Kalpathy-Cramer, J; Gerstner, ER; Batchelor, TT; Barboriak, DP; Rosen, BR; Schmainda, KM
MLA Citation
Prah, MA, Stufflebeam, SM, Paulson, ES, Kalpathy-Cramer, J, Gerstner, ER, Batchelor, TT, Barboriak, DP, Rosen, BR, and Schmainda, KM. "Repeatability of Standardized and Normalized Relative CBV in Patients with Newly Diagnosed Glioblastoma." AJNR. American journal of neuroradiology 36.9 (September 2015): 1654-1661.
PMID
26066626
Source
epmc
Published In
American Journal of Neuroradiology
Volume
36
Issue
9
Publish Date
2015
Start Page
1654
End Page
1661
DOI
10.3174/ajnr.a4374

Consensus recommendations for a standardized Brain Tumor Imaging Protocol in clinical trials.

A recent joint meeting was held on January 30, 2014, with the US Food and Drug Administration (FDA), National Cancer Institute (NCI), clinical scientists, imaging experts, pharmaceutical and biotech companies, clinical trials cooperative groups, and patient advocate groups to discuss imaging endpoints for clinical trials in glioblastoma. This workshop developed a set of priorities and action items including the creation of a standardized MRI protocol for multicenter studies. The current document outlines consensus recommendations for a standardized Brain Tumor Imaging Protocol (BTIP), along with the scientific and practical justifications for these recommendations, resulting from a series of discussions between various experts involved in aspects of neuro-oncology neuroimaging for clinical trials. The minimum recommended sequences include: (i) parameter-matched precontrast and postcontrast inversion recovery-prepared, isotropic 3D T1-weighted gradient-recalled echo; (ii) axial 2D T2-weighted turbo spin-echo acquired after contrast injection and before postcontrast 3D T1-weighted images to control timing of images after contrast administration; (iii) precontrast, axial 2D T2-weighted fluid-attenuated inversion recovery; and (iv) precontrast, axial 2D, 3-directional diffusion-weighted images. Recommended ranges of sequence parameters are provided for both 1.5 T and 3 T MR systems.

Authors
Ellingson, BM; Bendszus, M; Boxerman, J; Barboriak, D; Erickson, BJ; Smits, M; Nelson, SJ; Gerstner, E; Alexander, B; Goldmacher, G; Wick, W; Vogelbaum, M; Weller, M; Galanis, E; Kalpathy-Cramer, J; Shankar, L; Jacobs, P; Pope, WB; Yang, D; Chung, C; Knopp, MV; Cha, S; van den Bent, MJ; Chang, S; Yung, WKA; Cloughesy, TF; Wen, PY; Gilbert, MR
MLA Citation
Ellingson, BM, Bendszus, M, Boxerman, J, Barboriak, D, Erickson, BJ, Smits, M, Nelson, SJ, Gerstner, E, Alexander, B, Goldmacher, G, Wick, W, Vogelbaum, M, Weller, M, Galanis, E, Kalpathy-Cramer, J, Shankar, L, Jacobs, P, Pope, WB, Yang, D, Chung, C, Knopp, MV, Cha, S, van den Bent, MJ, Chang, S, Yung, WKA, Cloughesy, TF, Wen, PY, and Gilbert, MR. "Consensus recommendations for a standardized Brain Tumor Imaging Protocol in clinical trials." Neuro-oncology 17.9 (September 2015): 1188-1198. (Review)
PMID
26250565
Source
epmc
Published In
Neuro-Oncology
Volume
17
Issue
9
Publish Date
2015
Start Page
1188
End Page
1198
DOI
10.1093/neuonc/nov095

Dynamic susceptibility contrast MRI measures of relative cerebral blood volume as a prognostic marker for overall survival in recurrent glioblastoma: results from the ACRIN 6677/RTOG 0625 multicenter trial.

The study goal was to determine whether changes in relative cerebral blood volume (rCBV) derived from dynamic susceptibility contrast (DSC) MRI are predictive of overall survival (OS) in patients with recurrent glioblastoma multiforme (GBM) when measured 2, 8, and 16 weeks after treatment initiation.Patients with recurrent GBM (37/123) enrolled in ACRIN 6677/RTOG 0625, a multicenter, randomized, phase II trial of bevacizumab with irinotecan or temozolomide, consented to DSC-MRI plus conventional MRI, 21 with DSC-MRI at baseline and at least 1 postbaseline scan. Contrast-enhancing regions of interest were determined semi-automatically using pre- and postcontrast T1-weighted images. Mean tumor rCBV normalized to white matter (nRCBV) and standardized rCBV (sRCBV) were determined for these regions of interest. The OS rates for patients with positive versus negative changes from baseline in nRCBV and sRCBV were compared using Wilcoxon rank-sum and Kaplan-Meier survival estimates with log-rank tests.Patients surviving at least 1 year (OS-1) had significantly larger decreases in nRCBV at week 2 (P = .0451) and sRCBV at week 16 (P = .014). Receiver operating characteristic analysis found the percent changes of nRCBV and sRCBV at week 2 and sRCBV at week 16, but not rCBV data at week 8, to be good prognostic markers for OS-1. Patients with positive change from baseline rCBV had significantly shorter OS than those with negative change at both week 2 and week 16 (P = .0015 and P = .0067 for nRCBV and P = .0251 and P = .0004 for sRCBV, respectively).Early decreases in rCBV are predictive of improved survival in patients with recurrent GBM treated with bevacizumab.

Authors
Schmainda, KM; Zhang, Z; Prah, M; Snyder, BS; Gilbert, MR; Sorensen, AG; Barboriak, DP; Boxerman, JL
MLA Citation
Schmainda, KM, Zhang, Z, Prah, M, Snyder, BS, Gilbert, MR, Sorensen, AG, Barboriak, DP, and Boxerman, JL. "Dynamic susceptibility contrast MRI measures of relative cerebral blood volume as a prognostic marker for overall survival in recurrent glioblastoma: results from the ACRIN 6677/RTOG 0625 multicenter trial." Neuro-oncology 17.8 (August 2015): 1148-1156.
PMID
25646027
Source
epmc
Published In
Neuro-Oncology
Volume
17
Issue
8
Publish Date
2015
Start Page
1148
End Page
1156
DOI
10.1093/neuonc/nou364

Response assessment criteria for brain metastases: proposal from the RANO group.

CNS metastases are the most common cause of malignant brain tumours in adults. Historically, patients with brain metastases have been excluded from most clinical trials, but their inclusion is now becoming more common. The medical literature is difficult to interpret because of substantial variation in the response and progression criteria used across clinical trials. The Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) working group is an international, multidisciplinary effort to develop standard response and progression criteria for use in clinical trials of treatment for brain metastases. Previous efforts have focused on aspects of trial design, such as patient population, variations in existing response and progression criteria, and challenges when incorporating neurological, neuro-cognitive, and quality-of-life endpoints into trials of patients with brain metastases. Here, we present our recommendations for standard response and progression criteria for the assessment of brain metastases in clinical trials. The proposed criteria will hopefully facilitate the development of novel approaches to this difficult problem by providing more uniformity in the assessment of CNS metastases across trials.

Authors
Lin, NU; Lee, EQ; Aoyama, H; Barani, IJ; Barboriak, DP; Baumert, BG; Bendszus, M; Brown, PD; Camidge, DR; Chang, SM; Dancey, J; de Vries, EGE; Gaspar, LE; Harris, GJ; Hodi, FS; Kalkanis, SN; Linskey, ME; Macdonald, DR; Margolin, K; Mehta, MP; Schiff, D; Soffietti, R; Suh, JH; van den Bent, MJ; Vogelbaum, MA; Wen, PY
MLA Citation
Lin, NU, Lee, EQ, Aoyama, H, Barani, IJ, Barboriak, DP, Baumert, BG, Bendszus, M, Brown, PD, Camidge, DR, Chang, SM, Dancey, J, de Vries, EGE, Gaspar, LE, Harris, GJ, Hodi, FS, Kalkanis, SN, Linskey, ME, Macdonald, DR, Margolin, K, Mehta, MP, Schiff, D, Soffietti, R, Suh, JH, van den Bent, MJ, Vogelbaum, MA, and Wen, PY. "Response assessment criteria for brain metastases: proposal from the RANO group." The Lancet. Oncology 16.6 (June 2015): e270-e278.
PMID
26065612
Source
epmc
Published In
The Lancet Oncology
Volume
16
Issue
6
Publish Date
2015
Start Page
e270
End Page
e278
DOI
10.1016/s1470-2045(15)70057-4

Diffusion MRI quality control and functional diffusion map results in ACRIN 6677/RTOG 0625: a multicenter, randomized, phase II trial of bevacizumab and chemotherapy in recurrent glioblastoma.

Functional diffusion mapping (fDM) is a cancer imaging technique that quantifies voxelwise changes in apparent diffusion coefficient (ADC). Previous studies have shown value of fDMs in bevacizumab therapy for recurrent glioblastoma multiforme (GBM). The aim of the present study was to implement explicit criteria for diffusion MRI quality control and independently evaluate fDM performance in a multicenter clinical trial (RTOG 0625/ACRIN 6677). A total of 123 patients were enrolled in the current multicenter trial and signed institutional review board-approved informed consent at their respective institutions. MRI was acquired prior to and 8 weeks following therapy. A 5-point QC scoring system was used to evaluate DWI quality. fDM performance was evaluated according to the correlation of these metrics with PFS and OS at the first follow-up time-point. Results showed ADC variability of 7.3% in NAWM and 10.5% in CSF. A total of 68% of patients had usable DWI data and 47% of patients had high quality DWI data when also excluding patients that progressed before the first follow-up. fDM performance was improved by using only the highest quality DWI. High pre-treatment contrast enhancing tumor volume was associated with shorter PFS and OS. A high volume fraction of increasing ADC after therapy was associated with shorter PFS, while a high volume fraction of decreasing ADC was associated with shorter OS. In summary, DWI in multicenter trials are currently of limited value due to image quality. Improvements in consistency of image quality in multicenter trials are necessary for further advancement of DWI biomarkers.

Authors
Ellingson, BM; Kim, E; Woodworth, DC; Marques, H; Boxerman, JL; Safriel, Y; McKinstry, RC; Bokstein, F; Jain, R; Chi, TL; Sorensen, AG; Gilbert, MR; Barboriak, DP
MLA Citation
Ellingson, BM, Kim, E, Woodworth, DC, Marques, H, Boxerman, JL, Safriel, Y, McKinstry, RC, Bokstein, F, Jain, R, Chi, TL, Sorensen, AG, Gilbert, MR, and Barboriak, DP. "Diffusion MRI quality control and functional diffusion map results in ACRIN 6677/RTOG 0625: a multicenter, randomized, phase II trial of bevacizumab and chemotherapy in recurrent glioblastoma." International journal of oncology 46.5 (May 2015): 1883-1892.
PMID
25672376
Source
epmc
Published In
International journal of oncology
Volume
46
Issue
5
Publish Date
2015
Start Page
1883
End Page
1892
DOI
10.3892/ijo.2015.2891

Quantitative imaging biomarkers: a review of statistical methods for computer algorithm comparisons.

Quantitative biomarkers from medical images are becoming important tools for clinical diagnosis, staging, monitoring, treatment planning, and development of new therapies. While there is a rich history of the development of quantitative imaging biomarker (QIB) techniques, little attention has been paid to the validation and comparison of the computer algorithms that implement the QIB measurements. In this paper we provide a framework for QIB algorithm comparisons. We first review and compare various study designs, including designs with the true value (e.g. phantoms, digital reference images, and zero-change studies), designs with a reference standard (e.g. studies testing equivalence with a reference standard), and designs without a reference standard (e.g. agreement studies and studies of algorithm precision). The statistical methods for comparing QIB algorithms are then presented for various study types using both aggregate and disaggregate approaches. We propose a series of steps for establishing the performance of a QIB algorithm, identify limitations in the current statistical literature, and suggest future directions for research.

Authors
Obuchowski, NA; Reeves, AP; Huang, EP; Wang, X-F; Buckler, AJ; Kim, HJG; Barnhart, HX; Jackson, EF; Giger, ML; Pennello, G; Toledano, AY; Kalpathy-Cramer, J; Apanasovich, TV; Kinahan, PE; Myers, KJ; Goldgof, DB; Barboriak, DP; Gillies, RJ; Schwartz, LH; Sullivan, DC
MLA Citation
Obuchowski, NA, Reeves, AP, Huang, EP, Wang, X-F, Buckler, AJ, Kim, HJG, Barnhart, HX, Jackson, EF, Giger, ML, Pennello, G, Toledano, AY, Kalpathy-Cramer, J, Apanasovich, TV, Kinahan, PE, Myers, KJ, Goldgof, DB, Barboriak, DP, Gillies, RJ, Schwartz, LH, and Sullivan, DC. "Quantitative imaging biomarkers: a review of statistical methods for computer algorithm comparisons." Statistical methods in medical research 24.1 (February 2015): 68-106. (Review)
PMID
24919829
Source
epmc
Published In
Statistical Methods in Medical Research
Volume
24
Issue
1
Publish Date
2015
Start Page
68
End Page
106
DOI
10.1177/0962280214537390

Repeatability of quantitative metrics derived from MR diffusion tractography in paediatric patients with epilepsy.

OBJECTIVE: To quantify the test-retest repeatability of mean diffusivity (MD) and fractional anisotropy (FA) derived from diffusion tensor imaging (DTI) tractography in a cohort of paediatric patients with localization-related epilepsy. METHODS: 30 patients underwent 2 DTI acquisitions [repetition time/echo time (ms), 7000/90; flip, 90°; b-value, 1000 s mm(-2); voxel (mm), 2 × 2 × 2]. Two observers used Diffusion Toolkit and TrackVis ( www.trackvis.org ) to segment and analyse the following tracts: corpus callosum, corticospinal tracts, arcuate fasciculi, inferior longitudinal fasciculi and inferior fronto-occipital fasciculi. Mean MD and mean FA were calculated for each tract. Each observer independently analysed one of the DTI data sets for every patient. RESULTS: Segmentation identified all tracts in all subjects, except the arcuate fasciculus. There was a highly consistent relationship between repeated observations of MD (r = 0.993; p < 0.0001) and FA (r = 0.990; p < 0.0001). For each tract, coefficients of variation ranged from 0.9% to 2.1% for MD and from 1.5% to 2.8% for FA. The 95% confidence limits (CLs) for change ranged from 2.8% to 6% for MD and from 4.3% to 8.6% for FA. For the arcuate fasciculus, Cohen's κ for agreement between the observers (identifiable vs not identifiable) was 1.0. CONCLUSION: We quantified the repeatability of two commonly utilized scalar metrics derived from DTI tractography. For an individual patient, changes greater than the repeatability coefficient or 95% CLs for change are unlikely to be related to variability in their measurement. ADVANCES IN KNOWLEDGE: Reproducibility of these metrics will aid in the design of future studies and might one day be used to guide management in patients with epilepsy.

Authors
Paldino, MJ; Hedges, K; Rodrigues, KM; Barboriak, DP
MLA Citation
Paldino, MJ, Hedges, K, Rodrigues, KM, and Barboriak, DP. "Repeatability of quantitative metrics derived from MR diffusion tractography in paediatric patients with epilepsy." The British journal of radiology 87.1037 (May 2014): 20140095-.
PMID
24720623
Source
epmc
Published In
British Journal of Radiology
Volume
87
Issue
1037
Publish Date
2014
Start Page
20140095
DOI
10.1259/bjr.20140095

A fully automatic extraction of magnetic resonance image features in glioblastoma patients.

Glioblastoma is the most common malignant brain tumor. It is characterized by low median survival time and high survival variability. Survival prognosis for glioblastoma is very important for optimized treatment planning. Imaging features observed in magnetic resonance (MR) images were shown to be a good predictor of survival. However, manual assessment of MR features is time-consuming and can be associated with a high inter-reader variability as well as inaccuracies in the assessment. In response to this limitation, the authors proposed and evaluated a computer algorithm that extracts important MR image features in a fully automatic manner.The algorithm first automatically segmented the available volumes into a background region and four tumor regions. Then, it extracted ten features from the segmented MR imaging volumes, some of which were previously indicated as predictive of clinical outcomes. To evaluate the algorithm, the authors compared the extracted features for 73 glioblastoma patients to the reference standard established by manual segmentation of the tumors.The experiments showed that their algorithm was able to extract most of the image features with moderate to high accuracy. High correlation coefficients between the automatically extracted value and reference standard were observed for the tumor location, minor and major axis length as well as tumor volume. Moderately high correlation coefficients were also observed for proportion of enhancing tumor, proportion of necrosis, and thickness of enhancing margin. The correlation coefficients for all these features were statistically significant (p < 0.0001).The authors proposed and evaluated an algorithm that, given a set of MR volumes of a glioblastoma patient, is able to extract MR image features that correlate well with their reference standard. Future studies will evaluate how well the computer-extracted features predict survival.

Authors
Zhang, J; Barboriak, DP; Hobbs, H; Mazurowski, MA
MLA Citation
Zhang, J, Barboriak, DP, Hobbs, H, and Mazurowski, MA. "A fully automatic extraction of magnetic resonance image features in glioblastoma patients." Medical physics 41.4 (April 2014): 042301-.
PMID
24694151
Source
epmc
Published In
Medical physics
Volume
41
Issue
4
Publish Date
2014
Start Page
042301
DOI
10.1118/1.4866218

Magnetic resonance spectroscopy as an early indicator of response to anti-angiogenic therapy in patients with recurrent glioblastoma: RTOG 0625/ACRIN 6677.

BACKGROUND: The prognosis for patients with recurrent glioblastoma remains poor. The purpose of this study was to assess the potential role of MR spectroscopy as an early indicator of response to anti-angiogenic therapy. METHODS: Thirteen patients with recurrent glioblastoma were enrolled in RTOG 0625/ACRIN 6677, a prospective multicenter trial in which bevacizumab was used in combination with either temozolomide or irinotecan. Patients were scanned prior to treatment and at specific timepoints during the treatment regimen. Postcontrast T1-weighted MRI was used to assess 6-month progression-free survival. Spectra from the enhancing tumor and peritumoral regions were defined on the postcontrast T1-weighted images. Changes in the concentration ratios of n-acetylaspartate/creatine (NAA/Cr), choline-containing compounds (Cho)/Cr, and NAA/Cho were quantified in comparison with pretreatment values. RESULTS: NAA/Cho levels increased and Cho/Cr levels decreased within enhancing tumor at 2 weeks relative to pretreatment levels (P = .048 and P = .016, respectively), suggesting a possible antitumor effect of bevacizumab with cytotoxic chemotherapy. Nine of the 13 patients were alive and progression free at 6 months. Analysis of receiver operating characteristic curves for NAA/Cho changes in tumor at 8 weeks revealed higher levels in patients progression free at 6 months (area under the curve = 0.85), suggesting that NAA/Cho is associated with treatment response. Similar results were observed for receiver operating characteristic curve analyses against 1-year survival. In addition, decreased Cho/Cr and increased NAA/Cr and NAA/Cho in tumor periphery at 16 weeks posttreatment were associated with both 6-month progression-free survival and 1-year survival. CONCLUSION: Changes in NAA and Cho by MR spectroscopy may potentially be useful as imaging biomarkers in assessing response to anti-angiogenic treatment.

Authors
Ratai, E-M; Zhang, Z; Snyder, BS; Boxerman, JL; Safriel, Y; McKinstry, RC; Bokstein, F; Gilbert, MR; Sorensen, AG; Barboriak, DP
MLA Citation
Ratai, E-M, Zhang, Z, Snyder, BS, Boxerman, JL, Safriel, Y, McKinstry, RC, Bokstein, F, Gilbert, MR, Sorensen, AG, and Barboriak, DP. "Magnetic resonance spectroscopy as an early indicator of response to anti-angiogenic therapy in patients with recurrent glioblastoma: RTOG 0625/ACRIN 6677." Neuro Oncol 15.7 (July 2013): 936-944.
PMID
23645534
Source
pubmed
Published In
Neuro-Oncology
Volume
15
Issue
7
Publish Date
2013
Start Page
936
End Page
944
DOI
10.1093/neuonc/not044

Early post-bevacizumab progression on contrast-enhanced MRI as a prognostic marker for overall survival in recurrent glioblastoma: results from the ACRIN 6677/RTOG 0625 Central Reader Study.

BACKGROUND: RTOG 0625/ACRIN 6677 is a multicenter, randomized, phase II trial of bevacizumab with irinotecan or temozolomide in recurrent glioblastoma (GBM). This study investigated whether early posttreatment progression on FLAIR or postcontrast MRI assessed by central reading predicts overall survival (OS). METHODS: Of 123 enrolled patients, 107 had baseline and at least 1 posttreatment MRI. Two central neuroradiologists serially measured bidimensional (2D) and volumetric (3D) enhancement on postcontrast T1-weighted images and volume of FLAIR hyperintensity. Progression status on all posttreatment MRIs was determined using Macdonald and RANO imaging threshold criteria, with a third neuroradiologist adjudicating discrepancies of both progression occurrence and timing. For each MRI pulse sequence, Kaplan-Meier survival estimates and log-rank test were used to compare OS between cases with or without radiologic progression. RESULTS: Radiologic progression occurred after 2 chemotherapy cycles (8 weeks) in 9 of 97 (9%), 9 of 73 (12%), and 11 of 98 (11%) 2D-T1, 3D-T1, and FLAIR cases, respectively, and 34 of 80 (43%), 21 of 58 (36%), and 37 of 79 (47%) corresponding cases after 4 cycles (16 weeks). Median OS among patients progressing at 8 or 16 weeks was significantly less than that among nonprogressors, as determined on 2D-T1 (114 vs 278 days and 214 vs 426 days, respectively; P < .0001 for both) and 3D-T1 (117 vs 306 days [P < .0001] and 223 vs 448 days [P = .0003], respectively) but not on FLAIR (201 vs 276 days [P = .38] and 303 vs 321 days [P = .13], respectively). CONCLUSION: Early progression on 2D-T1 and 3D-T1, but not FLAIR MRI, after 8 and 16 weeks of anti-vascular endothelial growth factor therapy has highly significant prognostic value for OS in recurrent GBM.

Authors
Boxerman, JL; Zhang, Z; Safriel, Y; Larvie, M; Snyder, BS; Jain, R; Chi, TL; Sorensen, AG; Gilbert, MR; Barboriak, DP
MLA Citation
Boxerman, JL, Zhang, Z, Safriel, Y, Larvie, M, Snyder, BS, Jain, R, Chi, TL, Sorensen, AG, Gilbert, MR, and Barboriak, DP. "Early post-bevacizumab progression on contrast-enhanced MRI as a prognostic marker for overall survival in recurrent glioblastoma: results from the ACRIN 6677/RTOG 0625 Central Reader Study." Neuro Oncol 15.7 (July 2013): 945-954.
PMID
23788270
Source
pubmed
Published In
Neuro-Oncology
Volume
15
Issue
7
Publish Date
2013
Start Page
945
End Page
954
DOI
10.1093/neuonc/not049

Gliosarcoma metastatic to the leptomeninges and dura.

We describe a rare case of a patient with left frontotemporal gliosarcoma, which metastasized through the cerebrospinal fluid (CSF) to the leptomeninges and pachymeninges. Pathologically confirmed, magnetic resonance imaging-visible leptomeningeal spread of gliosarcoma via the CSF has not been previously reported.

Authors
Mansouri, B; Barboriak, DP; Kilani, RK
MLA Citation
Mansouri, B, Barboriak, DP, and Kilani, RK. "Gliosarcoma metastatic to the leptomeninges and dura." J Neuroimaging 23.2 (April 2013): 245-247.
PMID
21883625
Source
pubmed
Published In
Journal of Neuroimaging
Volume
23
Issue
2
Publish Date
2013
Start Page
245
End Page
247
DOI
10.1111/j.1552-6569.2011.00641.x

Gliosarcoma Metastatic to the Leptomeninges and Dura

We describe a rare case of a patient with left frontotemporal gliosarcoma, which metastasized through the cerebrospinal fluid (CSF) to the leptomeninges and pachymeninges. Pathologically confirmed, magnetic resonance imaging-visible leptomeningeal spread of gliosarcoma via the CSF has not been previously reported. © 2011 by the American Society of Neuroimaging.

Authors
Mansouri, B; Barboriak, DP; Kilani, RK
MLA Citation
Mansouri, B, Barboriak, DP, and Kilani, RK. "Gliosarcoma Metastatic to the Leptomeninges and Dura." Journal of Neuroimaging 23.2 (2013): 245-247.
Source
scival
Published In
Journal of Neuroimaging
Volume
23
Issue
2
Publish Date
2013
Start Page
245
End Page
247
DOI
10.1111/j.1552-6569.2011.00641.x

A change in the apparent diffusion coefficient after treatment with bevacizumab is associated with decreased survival in patients with recurrent glioblastoma multiforme.

OBJECTIVES: The aim of this study was to determine the prognostic significance of changes in parameters derived from diffusion tensor imaging (DTI) that occur in response to treatment with bevacizumab and irinotecan in patients with recurrent glioblastoma multiforme. METHODS: 15 patients with recurrent glioblastoma multiforme underwent serial 1.5 T MRI. Axial single-shot echo planar DTI was obtained on scans performed 3 days and 1 day prior to and 6 weeks after initiation of therapy with bevacizumab and irinotecan. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) maps were registered to whole brain contrast-enhanced three-dimensional (3D) spoiled gradient recalled and 3D fluid attenuation inversion recovery (FLAIR) image volumes. Anatomic image volumes were segmented to isolate regions of interest defined by tumour-related enhancement (TRE) and FLAIR signal abnormality (FSA). Mean ADC and mean FA were calculated for each region. A Bland-Altman repeatability coefficient was also calculated for each parameter based on the two pre-treatment studies. A patient was considered to have a change in FA or ADC after therapy if the difference between the pre- and post-treatment values was greater than the repeatability coefficient for that parameter. Survival was compared using a Cox proportional hazard model. RESULTS: DTI detected a change in ADC within FSA after therapy in nine patients (five in whom ADC was increased; four in whom it was decreased). Patients with a change in ADC within FSA had significantly shorter overall survival (p=0.032) and progression free survival (p=0.046) than those with no change. CONCLUSION: In patients with recurrent glioblastoma multiforme treated with bevacizumab and irinotecan, a change in ADC after therapy in FSA is associated with decreased survival.

Authors
Paldino, MJ; Desjardins, A; Friedman, HS; Vredenburgh, JJ; Barboriak, DP
MLA Citation
Paldino, MJ, Desjardins, A, Friedman, HS, Vredenburgh, JJ, and Barboriak, DP. "A change in the apparent diffusion coefficient after treatment with bevacizumab is associated with decreased survival in patients with recurrent glioblastoma multiforme." Br J Radiol 85.1012 (April 2012): 382-389.
PMID
21224297
Source
pubmed
Published In
British Journal of Radiology
Volume
85
Issue
1012
Publish Date
2012
Start Page
382
End Page
389
DOI
10.1259/bjr/24774491

Dynamic contrast-enhanced MRI in head-and-neck cancer: the impact of region of interest selection on the intra- and interpatient variability of pharmacokinetic parameters.

PURPOSE: Dynamic contrast-enhanced (DCE) MRI-extracted parameters measure tumor microvascular physiology and are usually calculated from an intratumor region of interest (ROI). Optimal ROI delineation is not established. The valid clinical use of DCE-MRI requires that the variation for any given parameter measured within a tumor be less than that observed between tumors in different patients. This work evaluates the impact of tumor ROI selection on the assessment of intra- and interpatient variability. METHOD AND MATERIALS: Head and neck cancer patients received initial targeted therapy (TT) treatment with erlotinib and/or bevacizumab, followed by radiotherapy and concurrent cisplatin with synchronous TT. DCE-MRI data from Baseline and the end of the TT regimen (Lead-In) were analyzed to generate the vascular transfer function (K(trans)), the extracellular volume fraction (v(e)), and the initial area under the concentration time curve (iAUC(1 min)). Four ROI sampling strategies were used: whole tumor or lymph node (Whole), the slice containing the most enhancing voxels (SliceMax), three slices centered in SliceMax (Partial), and the 5% most enhancing contiguous voxels within SliceMax (95Max). The average coefficient of variation (aCV) was calculated to establish intrapatient variability among ROI sets and interpatient variability for each ROI type. The average ratio between each intrapatient CV and the interpatient CV was calculated (aRCV). RESULTS: Baseline primary/nodes aRCVs for different ROIs not including 95Max were, for all three MR parameters, in the range of 0.14-0.24, with Lead-In values between 0.09 and 0.2, meaning a low intrapatient vs. interpatient variation. For 95Max, intrapatient CVs approximated interpatient CVs, meaning similar data dispersion and higher aRCVs (0.6-1.27 for baseline) and 0.54-0.95 for Lead-In. CONCLUSION: Distinction between different patient's primary tumors and/or nodes cannot be made using 95Max ROIs. The other three strategies are viable and equivalent for using DCE-MRI to measure head and neck cancer physiology.

Authors
Craciunescu, OI; Yoo, DS; Cleland, E; Muradyan, N; Carroll, MD; MacFall, JR; Barboriak, DP; Brizel, DM
MLA Citation
Craciunescu, OI, Yoo, DS, Cleland, E, Muradyan, N, Carroll, MD, MacFall, JR, Barboriak, DP, and Brizel, DM. "Dynamic contrast-enhanced MRI in head-and-neck cancer: the impact of region of interest selection on the intra- and interpatient variability of pharmacokinetic parameters." Int J Radiat Oncol Biol Phys 82.3 (March 1, 2012): e345-e350.
PMID
21985945
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
82
Issue
3
Publish Date
2012
Start Page
e345
End Page
e350
DOI
10.1016/j.ijrobp.2011.05.059

Apparent diffusion coefficient histogram analysis stratifies progression-free and overall survival in patients with recurrent GBM treated with bevacizumab: A multi-center study

We have tested the predictive value of apparent diffusion coefficient (ADC) histogram analysis in stratifying progression-free survival (PFS) and overall survival (OS) in bevacizumab-treated patients with recurrent glioblastoma multiforme (GBM) from the multi-center BRAIN study. Available MRI's from patients enrolled in the BRAIN study (n = 97) were examined by generating ADC histograms from areas of enhancing tumor on T1 weighted post-contrast images fitted to a two normal distribution mixture curve. ADC classifiers including the mean ADC from the lower curve (ADC-L) and the mean lower curve proportion (LCP) were tested for their ability to stratify PFS and OS by using Cox proportional hazard ratios and the Kaplan-Meier method with log-rank test. Mean ADC-L was 1,209 9 10-6mm2/s ± 224 (SD), and mean LCP was 0.71 ± 0.23 (SD). Low ADC-L was associated with worse outcome. The hazard ratios for 6-month PFS, overall PFS, and OS in patients with less versus greater than mean ADC-L were 3.1 (95 % confidence interval: 1.6, 6.1; P = 0.001), 2.3 (95 % CI: 1.3, 4.0; P = 0.002), and 2.4 (95 % CI: 1.4, 4.2; P = 0.002), respectively. In patients with ADC-L\1,209 and LCP[0.71 versus ADC-L[1,209 and LCP \0.71, there was a 2.28-fold reduction in the median time to progression, and a 1.42-fold decrease in the median OS. The predictive value of ADC histogram analysis, in which low ADC-L was associated with poor outcome, was confirmed in bevacizumab-treated patients with recurrent GBM in a post hoc analysis from the multicenter (BRAIN) study. © 2012 Springer Science+Business Media, LLC.

Authors
Pope, WB; Qiao, XJ; Kim, HJ; Lai, A; Nghiemphu, P; Xue, X; Ellingson, BM; Schiff, D; Aregawi, D; Cha, S; Puduvalli, VK; Wu, J; Yung, W-KA; Young, GS; Vredenburgh, J; Barboriak, D; Abrey, LE; Mikkelsen, T; Jain, R; Paleologos, NA; Rn, PL; Prados, M; Goldin, J; Wen, PY; Cloughesy, T
MLA Citation
Pope, WB, Qiao, XJ, Kim, HJ, Lai, A, Nghiemphu, P, Xue, X, Ellingson, BM, Schiff, D, Aregawi, D, Cha, S, Puduvalli, VK, Wu, J, Yung, W-KA, Young, GS, Vredenburgh, J, Barboriak, D, Abrey, LE, Mikkelsen, T, Jain, R, Paleologos, NA, Rn, PL, Prados, M, Goldin, J, Wen, PY, and Cloughesy, T. "Apparent diffusion coefficient histogram analysis stratifies progression-free and overall survival in patients with recurrent GBM treated with bevacizumab: A multi-center study." Journal of Neuro-Oncology 108.3 (2012): 491-498.
PMID
22426926
Source
scival
Published In
Journal of Neuro-Oncology
Volume
108
Issue
3
Publish Date
2012
Start Page
491
End Page
498
DOI
10.1007/s11060-012-0847-y

Colocalization of gadolinium-diethylene triamine pentaacetic acid with high-molecular-weight molecules after intracerebral convection-enhanced delivery in humans.

BACKGROUND: Convection-enhanced delivery (CED) permits site-specific therapeutic drug delivery within interstitial spaces at increased dosages through circumvention of the blood-brain barrier. CED is currently limited by suboptimal methodologies for monitoring the delivery of therapeutic agents that would permit technical optimization and enhanced therapeutic efficacy. OBJECTIVE: To determine whether a readily available small-molecule MRI contrast agent, gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA), could effectively track the distribution of larger therapeutic agents. METHODS: Gd-DTPA was coinfused with the larger molecular tracer, I-labeled human serum albumin (I-HSA), during CED of an EGFRvIII-specific immunotoxin as part of treatment for a patient with glioblastoma. RESULTS: Infusion of both tracers was safe in this patient. Analysis of both Gd-DTPA and I-HSA during and after infusion revealed a high degree of anatomical and volumetric overlap. CONCLUSION: Gd-DTPA may be able to accurately demonstrate the anatomic and volumetric distribution of large molecules used for antitumor therapy with high resolution and in combination with fluid-attenuated inversion recovery (FLAIR) imaging, and provide additional information about leaks into cerebrospinal fluid spaces and resection cavities. Similar studies should be performed in additional patients to validate our findings and help refine the methodologies we used.

Authors
Sampson, JH; Brady, M; Raghavan, R; Mehta, AI; Friedman, AH; Reardon, DA; Petry, NA; Barboriak, DP; Wong, TZ; Zalutsky, MR; Lally-Goss, D; Bigner, DD
MLA Citation
Sampson, JH, Brady, M, Raghavan, R, Mehta, AI, Friedman, AH, Reardon, DA, Petry, NA, Barboriak, DP, Wong, TZ, Zalutsky, MR, Lally-Goss, D, and Bigner, DD. "Colocalization of gadolinium-diethylene triamine pentaacetic acid with high-molecular-weight molecules after intracerebral convection-enhanced delivery in humans." Neurosurgery 69.3 (September 2011): 668-676.
PMID
21430586
Source
pubmed
Published In
Neurosurgery
Volume
69
Issue
3
Publish Date
2011
Start Page
668
End Page
676
DOI
10.1227/NEU.0b013e3182181ba8

Prognostic significance of parameters derived from co-registered 18F-fluorodeoxyglucose PET and contrast-enhanced MRI in patients with high-grade glioma.

OBJECTIVE: The aim of this study was to determine the prognostic significance of the volume and intensity of abnormal (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) accumulation within areas of contrast enhancement on post-therapeutic volumetric MRI. METHODS: A total of 10 patients with Grade III or IV glioma were treated with resection followed by intracavitary radiation therapy with (131)I-labelled antitenascin monoclonal antibody. Patients underwent serial FDG-PET and 1.5 T MR imaging. For each patient, MR and FDG-PET image volumes at each time point were aligned using a rigid-body normalised mutual information algorithm. Contrast-enhancing regions of interest (ROIs) were defined using a semi-automated k-means clustering technique. Activity within the ROI on the co-registered PET scan was calculated as a ratio (mean activity ratio; MAR) to activity in contralateral normal-appearing white matter (NAWM). The PET lesion was defined as the portion of the ROI associated with activity greater than two standard deviations above the mean in NAWM. Survival was assessed using the logrank test. RESULTS: Larger contrast-enhancing ROIs were strongly associated with an increased MAR (r = 0.51; p<0.002). Enhancing lesions with an MAR >1.2 were associated with decreased survival (p<0.016). In nine patients who died, the MAR on PET correlated inversely with survival duration (r = -0.43; p<0.01), whereas PET lesion volume did not. CONCLUSION: Following intracavitary radiation therapy, the development of contrast-enhancing lesions that are associated with high mean FDG-PET accumulation suggests poor prognosis.

Authors
Paldino, MJ; Wong, TZ; Reardon, DA; Friedman, HS; Barboriak, DP
MLA Citation
Paldino, MJ, Wong, TZ, Reardon, DA, Friedman, HS, and Barboriak, DP. "Prognostic significance of parameters derived from co-registered 18F-fluorodeoxyglucose PET and contrast-enhanced MRI in patients with high-grade glioma." Br J Radiol 84.1000 (April 2011): 327-333.
PMID
20959370
Source
pubmed
Published In
British Journal of Radiology
Volume
84
Issue
1000
Publish Date
2011
Start Page
327
End Page
333
DOI
10.1259/bjr/48528504

Noncompartmental kinetic analysis of DCE-MRI data from malignant tumors: Application to glioblastoma treated with bevacizumab.

Dynamic contrast enhanced MRI contrast agent kinetics in malignant tumors are typically complex, requiring multicompartment tumor models for adequate description. For consistent comparisons among tumors or among successive studies of the same tumor, we propose to estimate the total contrast agent-accessible volume fraction of tumor, including blood plasma, v(pe), and an average transfer rate constant across all tumor compartments, K(trans.av), by fitting a three-compartment tumor model and then calculating the area under the tumor impulse-response function (= v(pe)) and the ratio area under the tumor impulse response function over mean residence time in tumor (= K(trans.av)). If the duration of dynamic contrast enhanced MRI was too short to extrapolate the tumor impulse-response function to infinity with any confidence, then conditional parameters v(pe)(*) and K(trans.av*) should be calculated from the available incomplete impulse response function. Median decreases of 33% were found for both v(pe)(*) and K(trans.av*) in glioblastoma patients (n = 16) 24 hours after the administration of bevacizumab (P < 0.001). Median total contrast-enhancing tumor volume was reduced by 18% (P < 0.0001). The combined changes of tumor volume, v(pe)(*), and K(trans.av*) suggest a reduction of true v(pe), possibly accompanied by a reduction of true K(trans.av). The proposed method provides estimates of a scale and a shape parameter to describe contrast agent kinetics of varying complexity in a uniform way.

Authors
Port, RE; Bernstein, LJ; Barboriak, DP; Xu, L; Roberts, TPL; van Bruggen, N
MLA Citation
Port, RE, Bernstein, LJ, Barboriak, DP, Xu, L, Roberts, TPL, and van Bruggen, N. "Noncompartmental kinetic analysis of DCE-MRI data from malignant tumors: Application to glioblastoma treated with bevacizumab." Magn Reson Med 64.2 (August 2010): 408-417.
PMID
20665785
Source
pubmed
Published In
Magnetic Resonance in Medicine
Volume
64
Issue
2
Publish Date
2010
Start Page
408
End Page
417
DOI
10.1002/mrm.22399

Dynamic contrast enhanced-MRI in head and neck cancer patients: variability of the precontrast longitudinal relaxation time (T10).

PURPOSE: Calculation of the precontrast longitudinal relaxation times (T10) is an integral part of the Tofts-based pharmacokinetic (PK) analysis of dynamic contrast enhanced-magnetic resonance images. The purpose of this study was to investigate the interpatient and over time variability of T10 in head and neck primary tumors and involved nodes and to determine the median T10 for primary and nodes (T10(p,n)). The authors also looked at the implication of using voxel-based T10 values versus region of interest (ROI)-based T10 on the calculated values for vascular permeability (K(trans)) and extracellular volume fraction (v(e)). METHODS: Twenty head and neck cancer patients receiving concurrent chemoradiation and molecularly targeted agents on a prospective trial comprised the study population. Voxel-based T10's were generated using a gradient echo sequence on a 1.5 T MR scanner using the variable flip angle method with two flip angles [J. A. Brookes et al., "Measurement of spin-lattice relaxation times with FLASH for dynamic MRI of the breast," Br. J. Radiol. 69, 206-214 (1996)]. The voxel-based T10, K(trans), and v(e) were calculated using iCAD's (Nashua, NH) software. The mean T10's in muscle and fat ROIs were calculated (T10(m,f)). To assess reliability of ROI drawing, T10(p,n) values from ROIs delineated by 2 users (A and B) were calculated as the average of the T10's for 14 patients. For a subset of three patients, the T10 variability from baseline to end of treatment was also investigated. The K(trans) and v(e) from primary and node ROIs were calculated using voxel-based T10 values and T10(p,n) and differences reported. RESULTS: The calculated T10 values for fat and muscle are within the range of values reported in literature for 1.5 T, i.e., T10(m) = 0.958 s and T10(f) = 0.303 s. The average over 14 patients of the T10's based on drawings by users A and B were T10(pA) = 0.804 s, T10(nA) = 0.760 s, T10(pB) = 0.849 s, and T10(nB) = 0.810 s. The absolute percentage difference between K(trans) and v(e) calculated with voxel-based T10 versus T10(p,n) ranged from 6% to 81% and from 2% to 24%, respectively. CONCLUSIONS: There is a certain amount of variability in the median T10 values between patients, but the differences are not significant. There were also no statistically significant differences between the T10 values for primary and nodes at baseline and the subsequent time points (p = 0.94 Friedman test). Voxel-based T10 calculations are essential when quantitative Tofts-based PK analysis in heterogeneous tumors is needed. In the absence of T10 mapping capability, when a relative, qualitative analysis is deemed sufficient, a value of T10(p,n) = 0.800 s can be used as an estimate for T10 for both the primary tumor and the affected nodes in head and neck cancers at all the time points considered.

Authors
Craciunescu, O; Brizel, D; Cleland, E; Yoo, D; Muradyan, N; Carroll, M; Barboriak, D; MacFall, J
MLA Citation
Craciunescu, O, Brizel, D, Cleland, E, Yoo, D, Muradyan, N, Carroll, M, Barboriak, D, and MacFall, J. "Dynamic contrast enhanced-MRI in head and neck cancer patients: variability of the precontrast longitudinal relaxation time (T10)." Med Phys 37.6 (June 2010): 2683-2692.
PMID
20632579
Source
pubmed
Published In
Medical physics
Volume
37
Issue
6
Publish Date
2010
Start Page
2683
End Page
2692
DOI
10.1118/1.3427487

An automated method for nonparametric kinetic analysis of clinical DCE-MRI data: application to glioblastoma treated with bevacizumab.

Here, we describe an automated nonparametric method for evaluating gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA) kinetics, based on dynamic contrast-enhanced-MRI scans of glioblastoma patients taken before and after treatment with bevacizumab; no specific model or equation structure is assumed or used. Tumor and venous blood concentration-time profiles are smoothed, using a robust algorithm that removes artifacts due to patient motion, and then deconvolved, yielding an impulse response function. In addition to smoothing, robustness of the deconvolution operation is assured by excluding data that occur prior to the plasma peak; an exhaustive analysis was performed to demonstrate that exclusion of the prepeak plasma data does not significantly affect results. All analysis steps are executed by a single R script that requires blood and tumor curves as the sole input. Statistical moment analysis of the Impulse response function yields the area under the curve (AUC) and mean residence time (MRT). Comparison of deconvolution results to fitted Tofts model parameters suggests that AUCMRT and AUC of the Impulse response function closely approximate fractional clearance from plasma to tissue (K(trans)) and fractional interstitial volume (v(e)). Intervisit variability is shown to be comparable when using the deconvolution method (11% [AUCMRT] and 13%[AUC]) compared to the Tofts model (14%[K(trans)] and 24%[v(e)]). AUC and AUCMRT both exhibit a statistically significant decrease (P < 0.005) 1 day after administration of bevacizumab.

Authors
Ferl, GZ; Xu, L; Friesenhahn, M; Bernstein, LJ; Barboriak, DP; Port, RE
MLA Citation
Ferl, GZ, Xu, L, Friesenhahn, M, Bernstein, LJ, Barboriak, DP, and Port, RE. "An automated method for nonparametric kinetic analysis of clinical DCE-MRI data: application to glioblastoma treated with bevacizumab." Magn Reson Med 63.5 (May 2010): 1366-1375.
PMID
20432307
Source
pubmed
Published In
Magnetic Resonance in Medicine
Volume
63
Issue
5
Publish Date
2010
Start Page
1366
End Page
1375
DOI
10.1002/mrm.22335

Trichothiodystrophy with dysmyelination and central osteosclerosis.

Trichothiodystrophy (TTD) is a rare group of autosomal recessive disorders of DNA repair unified by the presence of sulfur-deficient brittle hair. We report a 3-year-old boy with classic clinical features of TTD, including ichthyosis, alopecia, developmental delay, and tiger-tail banding of the hair shaft on polarizing microscopy. Brain MR imaging showed both diffuse dysmyelination and osteosclerosis, findings that, in combination, may be specific for TTD.

Authors
Harreld, JH; Smith, EC; Prose, NS; Puri, PK; Barboriak, DP
MLA Citation
Harreld, JH, Smith, EC, Prose, NS, Puri, PK, and Barboriak, DP. "Trichothiodystrophy with dysmyelination and central osteosclerosis." AJNR Am J Neuroradiol 31.1 (January 2010): 129-130.
PMID
20075106
Source
pubmed
Published In
American Journal of Neuroradiology
Volume
31
Issue
1
Publish Date
2010
Start Page
129
End Page
130
DOI
10.3174/ajnr.A1665

Applications of the repeatability of quantitative imaging biomarkers: a review of statistical analysis of repeat data sets.

Repeat imaging data sets performed on patients with cancer are becoming publicly available. The potential utility of these data sets for addressing important questions in imaging biomarker development is vast. In particular, these data sets may be useful to help characterize the variability of quantitative parameters derived from imaging. This article reviews statistical analysis that may be performed to use results of repeat imaging to 1) calculate the level of change in parameter value that may be seen in individual patients to confidently characterize that patient as showing true parameter change, 2) calculate the level of change in parameters value that may be seen in individual patients to confidently categorize that patient as showing true lack of parameter change, 3) determine if different imaging devices are interchangeable from the standpoint of repeatability, and 4) estimate the numbers of patients needed to precisely calculate repeatability. In addition, we recommend a set of statistical parameters that should be reported when the repeatability of continuous parameters is studied.

Authors
Barnhart, HX; Barboriak, DP
MLA Citation
Barnhart, HX, and Barboriak, DP. "Applications of the repeatability of quantitative imaging biomarkers: a review of statistical analysis of repeat data sets." Transl Oncol 2.4 (December 2009): 231-235.
PMID
19956383
Source
pubmed
Published In
Translational oncology
Volume
2
Issue
4
Publish Date
2009
Start Page
231
End Page
235

Quantitative imaging to assess tumor response to therapy: common themes of measurement, truth data, and error sources.

RATIONALE: Early detection of tumor response to therapy is a key goal. Finding measurement algorithms capable of early detection of tumor response could individualize therapy treatment as well as reduce the cost of bringing new drugs to market. On an individual basis, the urgency arises from the desire to prevent continued treatment of the patient with a high-cost and/or high-risk regimen with no demonstrated individual benefit and rapidly switch the patient to an alternative efficacious therapy for that patient. In the context of bringing new drugs to market, such algorithms could demonstrate efficacy in much smaller populations, which would allow phase 3 trials to achieve statistically significant decisions with fewer subjects in shorter trials. MATERIALS AND METHODS: This consensus-based article describes multiple, image modality-independent means to assess the relative performance of algorithms for measuring tumor change in response to therapy. In this setting, we describe specifically the example of measurement of tumor volume change from anatomic imaging as well as provide an overview of other promising generic analytic methods that can be used to assess change in heterogeneous tumors. To support assessment of the relative performance of algorithms for measuring small tumor change, data sources of truth are required. RESULTS: Very short interval clinical imaging examinations and phantom scans provide known truth for comparative evaluation of algorithms. CONCLUSIONS: For a given category of measurement methods, the algorithm that has the smallest measurement noise and least bias on average will perform best in early detection of true tumor change.

Authors
Meyer, CR; Armato, SG; Fenimore, CP; McLennan, G; Bidaut, LM; Barboriak, DP; Gavrielides, MA; Jackson, EF; McNitt-Gray, MF; Kinahan, PE; Petrick, N; Zhao, B
MLA Citation
Meyer, CR, Armato, SG, Fenimore, CP, McLennan, G, Bidaut, LM, Barboriak, DP, Gavrielides, MA, Jackson, EF, McNitt-Gray, MF, Kinahan, PE, Petrick, N, and Zhao, B. "Quantitative imaging to assess tumor response to therapy: common themes of measurement, truth data, and error sources." Transl Oncol 2.4 (December 2009): 198-210.
PMID
19956379
Source
pubmed
Published In
Translational oncology
Volume
2
Issue
4
Publish Date
2009
Start Page
198
End Page
210

Magnetic resonance assessment of response to therapy: tumor change measurement, truth data and error sources.

This article describes methods and issues that are specific to the assessment of change in tumor characteristics as measured using quantitative magnetic resonance (MR) techniques and how this relates to the establishment of quantitative MR imaging (MRI) biomarkers of patient response to therapy. The initial focus is on the various sources of bias and variance in the measurement of microvascular parameters and diffusion parameters as such parameters are being used relatively commonly as secondary or exploratory end points in current phase 1/2 clinical trails of conventional and targeted therapies. Several ongoing initiatives that seek to identify the magnitude of some of the sources of measurement variations are then discussed. Finally, resources being made available through the National Cancer Institute Reference Image Database to Evaluate Response (RIDER) project that might be of use in investigations of quantitative MRI biomarker change analysis are described. These resources include 1) data from phantom-based assessment of system response, including short-term (1 hour) and moderate-term (1 week) contrast response and relaxation time measurement, 2) data obtained from repeated dynamic contrast agent-enhanced MRI studies in intracranial tumors, and 3) data obtained from repeated diffusion MRI studies in both breast and brain. A concluding section briefly discusses issues that must be addressed to allow the transition of MR-based imaging biomarker measures from their current role as secondary/exploratory end points in clinical trials to primary/surrogate markers of response and, ultimately, in clinical application.

Authors
Jackson, EF; Barboriak, DP; Bidaut, LM; Meyer, CR
MLA Citation
Jackson, EF, Barboriak, DP, Bidaut, LM, and Meyer, CR. "Magnetic resonance assessment of response to therapy: tumor change measurement, truth data and error sources." Transl Oncol 2.4 (December 2009): 211-215.
PMID
19956380
Source
pubmed
Published In
Translational oncology
Volume
2
Issue
4
Publish Date
2009
Start Page
211
End Page
215

Ruptured maxillary retention cyst: cause of unilateral rhinorrhea after trauma.

This study describes a case of a patient with traumatic rupture of a maxillary sinus retention cyst, which had an interesting clinical presentation of unilateral rhinorrhea, mimicking a CSF leak. The diagnosis was made fortuitously by comparison of a posttraumatic CT brain examination with a CT sinus study performed 1 day earlier.

Authors
Hoang, JK; Smith, EC; Barboriak, DP
MLA Citation
Hoang, JK, Smith, EC, and Barboriak, DP. "Ruptured maxillary retention cyst: cause of unilateral rhinorrhea after trauma." AJNR Am J Neuroradiol 30.6 (June 2009): 1121-1122.
PMID
19439483
Source
pubmed
Published In
American Journal of Neuroradiology
Volume
30
Issue
6
Publish Date
2009
Start Page
1121
End Page
1122
DOI
10.3174/ajnr.A1457

Prognostic significance of early changes in the apparent diffusion coefficient that occurs after treatment of patients with glioblastoma multiforme with bevacizumab.

2058 Background: To determine the prognostic significance of changes in parameters derived from diffusion tensor imaging (DTI) that occur in response to combination chemotherapy with the antiangiogenesis agent bevacizumab (BEV) in patients with recurrent glioblastoma multiforme (GBM).16 patients (10 men, 6 women; age range 38-62 years) with recurrent GBM underwent serial 1.5T MR imaging. Axial single-shot echo planar DTI (TR/TE 6000/100; flip angle 90 degrees; voxel: 1.72 x 1.72 x 5mm; b value of 1000 sec/mm2; 12 directions) was obtained on scans performed 3 days and 1 day prior to and 1 day after initiation of therapy with BEV and irinotecan (CPT-11). Clinical follow-up and survival status was documented up to 20 months after the date of initial MR imaging. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) maps were aligned to whole brain contrast-enhanced 3D FLASH and 3D FLAIR image volumes (1 mm isotropic voxels) using a rigid body normalized mutual information algorithm. Based on two pre-treatment scans, the 95% confidence limits for change (95%CL) in ADC and FA were calculated in volumes of tumor-related contrast-enhancement (TRE) and FLAIR signal abnormality (FSA). A patient was considered to have a change in FA or ADC after therapy if the difference between the pre- and post-treatment values was greater than the 95% CL for that parameter. Progression was defined on contrast-enhanced MRI using MacDonald criteria by neuro-oncologists blinded to the DTI findings. Survival was compared using the log rank test.DTI detected a change in ADC within FSA after therapy in three patients (2 increased, 1 decreased). Patients with a change in ADC within FSA had significantly shorter overall (p < 0.0012) and progression free (p < 0.015) survival than those with no change. Median survival in the patient group with a change in ADC was 24.7 (95% CI [17.3, 39.4]) weeks and 56.4 (95% CI [41.7, 96]) weeks in those patients with no change.In patients with GBM treated with BEV and CPT-11, a change in ADC after therapy in areas of FSA is associated with decreased survival. Parameters derived from DTI may, therefore, potentially serve as early markers of treatment failure in patients with GBM. [Table: see text].

Authors
Paldino, M; Desjardins, A; Friedman, HS; Vredenburgh, JJ; Barboriak, DP
MLA Citation
Paldino, M, Desjardins, A, Friedman, HS, Vredenburgh, JJ, and Barboriak, DP. "Prognostic significance of early changes in the apparent diffusion coefficient that occurs after treatment of patients with glioblastoma multiforme with bevacizumab." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 27.15_suppl (May 2009): 2058-.
PMID
27964666
Source
epmc
Published In
Journal of Clinical Oncology
Volume
27
Issue
15_suppl
Publish Date
2009
Start Page
2058

Fundamentals of quantitative dynamic contrast-enhanced MR imaging.

Quantitative analysis of dynamic contrast-enhanced MR imaging (DCE-MR imaging) has the power to provide information regarding physiologic characteristics of the microvasculature and is, therefore, of great potential value to the practice of oncology. In particular, these techniques could have a significant impact on the development of novel anticancer therapies as a promising biomarker of drug activity. Standardization of DCE-MR imaging acquisition and analysis to provide more reproducible measures of tumor vessel physiology is of crucial importance to realize this potential. The purpose of this article is to review the pathophysiologic basis and technical aspects of DCE-MR imaging techniques.

Authors
Paldino, MJ; Barboriak, DP
MLA Citation
Paldino, MJ, and Barboriak, DP. "Fundamentals of quantitative dynamic contrast-enhanced MR imaging." Magn Reson Imaging Clin N Am 17.2 (May 2009): 277-289. (Review)
PMID
19406359
Source
pubmed
Published In
Magnetic Resonance Imaging Clinics of North America
Volume
17
Issue
2
Publish Date
2009
Start Page
277
End Page
289
DOI
10.1016/j.mric.2009.01.007

Repeatability of quantitative parameters derived from diffusion tensor imaging in patients with glioblastoma multiforme.

PURPOSE: To quantify the repeatability of apparent diffusion coefficient (ADC) and fractional anisotropy (FA) in patients with glioblastoma multiforme. MATERIALS AND METHODS: IRB approval and informed consent were obtained for this Health Insurance Portability and Accountability Act-compliant study. Sixteen patients with glioblastoma multiforme underwent MR imaging at two time points without interval intervention. ADC and FA maps were registered to the contrast-enhanced and fluid-attenuated inversion recovery (FLAIR) image volumes. Volumes of tumor-related enhancement (TRE) and FLAIR signal abnormality (FSA) were defined using a semiautomated segmentation technique. RESULTS: Repeated observations of mean ADC and mean FA were highly consistent within both TRE (ADC: r = 0.947,P < 0.0001; FA: r = 0.947, P < 0.0001) and FSA (ADC: r = 0.979, P < 0.0001; FA: r = 0.972, P < 0.0001). Within TRE, repeatability coefficients and 95% confidence intervals (CIs) for change measured 0.104 x 10(-3) mm(2)S(-1) and 7.4% (ADC) and 0.0196 and 13.9% (FA), respectively. Within FSA, repeatability coefficients and 95% CI for change measured 0.071 x 10(-3) mm(2)S(-1) and 5.2% (ADC) and 0.0159 and 8.7% (FA), respectively. To detect 10% changes in mean ADC, sample sizes of nine (TRE) and six (FSA) patients would be required. The same change in mean FA would require sample sizes of 21 (TRE) and 10 (FSA) patients, respectively. CONCLUSION: Changes after therapy greater than the repeatability coefficient or 95% CI for change are unlikely to be related to variability in the measurement of ADC and FA.

Authors
Paldino, MJ; Barboriak, D; Desjardins, A; Friedman, HS; Vredenburgh, JJ
MLA Citation
Paldino, MJ, Barboriak, D, Desjardins, A, Friedman, HS, and Vredenburgh, JJ. "Repeatability of quantitative parameters derived from diffusion tensor imaging in patients with glioblastoma multiforme." J Magn Reson Imaging 29.5 (May 2009): 1199-1205.
PMID
19388113
Source
pubmed
Published In
Journal of Magnetic Resonance Imaging
Volume
29
Issue
5
Publish Date
2009
Start Page
1199
End Page
1205
DOI
10.1002/jmri.21732

Comparison of three physiologically-based pharmacokinetic models for the prediction of contrast agent distribution measured by dynamic MR imaging.

PURPOSE: To compare the performance of three physiologically-based pharmacokinetic (PBPK) models for predicting gadolinium contrast agent concentration-time curves (Gd-CTCs) obtained in superior sagittal sinus (SSS), cerebral cortex, and psoas muscle. MATERIALS AND METHODS: Three published whole-body PBPK models were modified to predict Gd-CTCs in normal-appearing tissue. The models differed in the number of organs modeled and total number of compartments, and were designated as the "well-mixed," "delay," and "dispersion" models. The suitability of the three models to predict Gd-CTC was studied using data from dynamic contrast-enhanced MR perfusion imaging obtained at 1.5T from 10 patients with glioblastoma multiforme and at 3.0T from five patients with liver metastases. RESULTS: The dispersion model produced better fits than the delay model in the SSS (P < 0.0001) and cerebral cortex (P < 0.0001), and better fits than the well-mixed model in psoas muscle (P < 0.005). No model produced better fits than the dispersion model at any of the three locations. CONCLUSION: In this evaluation, the dispersion model was most robust for prediction of Gd-CTCs derived from dynamic contrast-enhanced (DCE)-MRI. This represents a preliminary step in the development of a PBPK model useful for predicting Gd-CTCs at a time resolution appropriate for dynamic MRI applications.

Authors
Barboriak, DP; MacFall, JR; Viglianti, BL; Dewhirst Dvm, MW
MLA Citation
Barboriak, DP, MacFall, JR, Viglianti, BL, and Dewhirst Dvm, MW. "Comparison of three physiologically-based pharmacokinetic models for the prediction of contrast agent distribution measured by dynamic MR imaging." J Magn Reson Imaging 27.6 (June 2008): 1388-1398.
PMID
18504759
Source
pubmed
Published In
Journal of Magnetic Resonance Imaging
Volume
27
Issue
6
Publish Date
2008
Start Page
1388
End Page
1398
DOI
10.1002/jmri.21344

Effect of bevacizumab (BEV) and irinotecan (CPT-11) on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in glioblastoma (GBM) patients

Authors
Desjardins, A; Barboriak, DP; II, HJE; Marcello, J; Reardon, DA; Quinn, JA; Rich, JN; Sathornsumetee, S; Friedman, HS; Vredenburgh, JJ
MLA Citation
Desjardins, A, Barboriak, DP, II, HJE, Marcello, J, Reardon, DA, Quinn, JA, Rich, JN, Sathornsumetee, S, Friedman, HS, and Vredenburgh, JJ. "Effect of bevacizumab (BEV) and irinotecan (CPT-11) on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in glioblastoma (GBM) patients." JOURNAL OF CLINICAL ONCOLOGY 26.15 (May 20, 2008).
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
26
Issue
15
Publish Date
2008

Hippocampal MRI signal hyperintensity after febrile status epilepticus is predictive of subsequent mesial temporal sclerosis.

OBJECTIVE: The objective of our study was to test the hypothesis that the finding of hyperintense hippocampal signal intensity on T2-weighted MR images soon after febrile status epilepticus is associated with subsequent hippocampal volume loss and persistent abnormal signal intensity on T2-weighted images (i.e., mesial temporal sclerosis). SUBJECTS AND METHODS: Eleven children (mean age, 25 months) underwent initial MRI that included coronal temporal lobe imaging within 72 hours of febrile status epilepticus and follow-up imaging from 3 to 23 months later (mean, 9 months). A neuroradiologist blinded to clinical history graded initial and follow-up hippocampal signal intensity on a scale from 0 (normal) to 4 (markedly increased). Two blinded observers measured hippocampal volumes on initial and follow-up MR studies using commercially available software and volumes from 30 healthy children (mean age, 6.3 years). Initial signal intensity and hippocampal volume changes were compared using Kendall tau correlation coefficients. RESULTS: On initial imaging, hyperintense signal intensity ranging from 1 (minimally increased) to 4 (markedly increased) was seen in seven children. Four children had at least one hippocampus with moderate or marked signal abnormality, three children had a hippocampus with mild or minimal abnormality, and four children had normal signal intensity. The Kendall tau correlation coefficient between signal intensity increase and volume change was -0.68 (p < 0.01). Five children (two with temporal lobe epilepsy and two with complex partial seizures) had hippocampal volume loss and increased signal intensity on follow-up imaging, meeting the criteria for mesial temporal sclerosis. CONCLUSION: MRI findings of a markedly hyperintense hippocampus in children with febrile status epilepticus was highly associated with subsequent mesial temporal sclerosis.

Authors
Provenzale, JM; Barboriak, DP; VanLandingham, K; MacFall, J; Delong, D; Lewis, DV
MLA Citation
Provenzale, JM, Barboriak, DP, VanLandingham, K, MacFall, J, Delong, D, and Lewis, DV. "Hippocampal MRI signal hyperintensity after febrile status epilepticus is predictive of subsequent mesial temporal sclerosis." AJR Am J Roentgenol 190.4 (April 2008): 976-983.
PMID
18356445
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
190
Issue
4
Publish Date
2008
Start Page
976
End Page
983
DOI
10.2214/AJR.07.2407

The Reference Image Database to Evaluate Response to therapy in lung cancer (RIDER) project: A resource for the development of change-analysis software

Critical to the clinical evaluation of effective novel therapies for lung cancer is the early and accurate determination of tumor response, which requires an understanding of the sources of uncertainty in tumor measurement and subsequent attempts to minimize their effects on the assessment of the therapeutic agent. The Reference Image Database to Evaluate Response (RIDER) project seeks to develop a consensus approach to the optimization and benchmarking of software tools for the assessment of tumor response to therapy and to provide a publicly available database of serial images acquired during lung cancer drug and radiation therapy trials. Images of phantoms and patient images acquired under situations in which tumor size or biology is known to be unchanged also will be provided. The RIDER project will create standardized methods for benchmarking software tools to reduce sources of uncertainty in vital clinical assessments such as whether a specific tumor is responding to therapy. © 2008 American Society for Clinical Pharmacology and Therapeutics.

Authors
III, SGA; Meyer, CR; McNitt-Gray, MF; McLennan, G; Reeves, AP; Croft, BY; Clarke, LP; Bidaut, L; Zhao, B; Fenimore, C; Kinahan, P; Jackson, E; Petrick, N; Aberle, DR; Kazerooni, EA; MacMahon, H; Beek, EJRV; Yankelevitz, D; Munden, R; Schwartz, L; Gavielides, M; Kinnard, L; Jaffe, C; Gottlieb, R; Brown, MS; Pais, RC; Qing, DP-Y; Farooqi, A; Cham, M; Max, D; Biancardi, A; Hoffman, E; Sprenger, K; Towfic, Z; Hudson, L; Sieren, J; Bland, PH; Laderach, G; Engelmann, R; Starkey, A; Barboriak, D et al.
MLA Citation
III, SGA, Meyer, CR, McNitt-Gray, MF, McLennan, G, Reeves, AP, Croft, BY, Clarke, LP, Bidaut, L, Zhao, B, Fenimore, C, Kinahan, P, Jackson, E, Petrick, N, Aberle, DR, Kazerooni, EA, MacMahon, H, Beek, EJRV, Yankelevitz, D, Munden, R, Schwartz, L, Gavielides, M, Kinnard, L, Jaffe, C, Gottlieb, R, Brown, MS, Pais, RC, Qing, DP-Y, Farooqi, A, Cham, M, Max, D, Biancardi, A, Hoffman, E, Sprenger, K, Towfic, Z, Hudson, L, Sieren, J, Bland, PH, Laderach, G, Engelmann, R, Starkey, A, and Barboriak, D et al. "The Reference Image Database to Evaluate Response to therapy in lung cancer (RIDER) project: A resource for the development of change-analysis software." Clinical Pharmacology and Therapeutics 84.4 (2008): 448-456.
PMID
18754000
Source
scival
Published In
Clinical Pharmacology & Therapeutics (Nature)
Volume
84
Issue
4
Publish Date
2008
Start Page
448
End Page
456
DOI
10.1038/clpt.2008.161

Gain in signal-to-noise for first-pass contrast-enhanced abdominal MR angiography at 3 Tesla over standard 1.5 Tesla: prediction with a computer model.

RATIONALE AND OBJECTIVES: To estimate the gain in signal-to-noise ratio (SNR) in first-pass contrast-enhanced (CE) abdominal magnetic resonance angiography (MRA) at 3.0 T compared with 1.5 T. MATERIALS AND METHODS: Three protocols were simulated using six contrast agents: gadopentetate dimeglumine (Magnevist, Berlex, Wayne, NJ), gadoteridol (Prohance, Bracco, Princeton, NJ), gadobenate dimeglumine (Multihance, Bracco, Princeton, NJ), gadodiamide (Omniscan, Amersham Health, Princeton, NJ), gadoversetamide (Optimark, Mallinckrodt, St. Louis, MO), and gadofosveset trisodium (MS-325, EPIX Medical, Cambridge, MA). Contrast concentrations were calculated for five abdominal vessels. Based on these data, the gain in SNR during CE abdominal MRA at 3.0 T over 1.5 T was estimated. RESULTS: In these simulations, peak concentrations in all five target vessels were about 5 mM, 10 mM, and 0.7 mM for protocol 1, protocol 2, and protocol 3, respectively. A gain in SNR at 3 T over 1.5 T during CE abdominal MRA of at least 94% in all five target vessels could be achieved by applying protocol 1 or protocol 2, whereas protocol 3 provided a gain in SNR of 70%. CONCLUSIONS: Although five of the contrast agents studied fulfill the expectation of providing approximately twice the SNR at 3.0 T versus 1.5 T during CE abdominal MRA, MS-325 offers a gain in SNR of 70% only.

Authors
Merkle, EM; Dale, BM; Barboriak, DP
MLA Citation
Merkle, EM, Dale, BM, and Barboriak, DP. "Gain in signal-to-noise for first-pass contrast-enhanced abdominal MR angiography at 3 Tesla over standard 1.5 Tesla: prediction with a computer model." Acad Radiol 14.7 (July 2007): 795-803.
PMID
17574130
Source
pubmed
Published In
Academic Radiology
Volume
14
Issue
7
Publish Date
2007
Start Page
795
End Page
803
DOI
10.1016/j.acra.2007.03.007

Chemodosimetry of in vivo tumor liposomal drug concentration using MRI.

Effective cancer chemotherapy depends on the delivery of therapeutic drugs to cancer cells at cytotoxic concentrations. However, physiologic barriers, such as variable vessel permeability, high interstitial fluid pressure, and heterogeneous perfusion, make it difficult to achieve that goal. Efforts to improve drug delivery have been limited by the lack of noninvasive tools to evaluate intratumoral drug concentration and distribution. Here we demonstrate that tumor drug concentration can be measured in vivo using T(1)-weighted MRI, following systemic administration of liposomes containing both drug (doxorubicin (DOX)) and contrast agent (manganese (Mn)). Mn and DOX concentrations were calculated using T(1) relaxation times and Mn:DOX loading ratios, as previously described. Two independent validations by high-performance liquid chromatography (HPLC) and histologic fluorescence in a rat fibrosarcoma (FSA) model indicate a concordant linear relationship between DOX concentrations determined using T(1) and those measured invasively. This method of imaging exhibits potential for real-time evaluation of chemotherapeutic protocols and prediction of tumor response on an individual patient basis.

Authors
Viglianti, BL; Ponce, AM; Michelich, CR; Yu, D; Abraham, SA; Sanders, L; Yarmolenko, PS; Schroeder, T; MacFall, JR; Barboriak, DP; Colvin, OM; Bally, MB; Dewhirst, MW
MLA Citation
Viglianti, BL, Ponce, AM, Michelich, CR, Yu, D, Abraham, SA, Sanders, L, Yarmolenko, PS, Schroeder, T, MacFall, JR, Barboriak, DP, Colvin, OM, Bally, MB, and Dewhirst, MW. "Chemodosimetry of in vivo tumor liposomal drug concentration using MRI." Magn Reson Med 56.5 (November 2006): 1011-1018.
PMID
17029236
Source
pubmed
Published In
Magnetic Resonance in Medicine
Volume
56
Issue
5
Publish Date
2006
Start Page
1011
End Page
1018
DOI
10.1002/mrm.21032

Diffusion-weighted and perfusion MR imaging for brain tumor characterization and assessment of treatment response.

Diffusion-weighted magnetic resonance (MR) imaging and perfusion MR imaging are advanced techniques that provide information not available from conventional MR imaging. In particular, these techniques have a number of applications with regard to characterization of tumors and assessment of tumor response to therapy. In this review, the authors describe the fundamental principles of diffusion-weighted and perfusion MR imaging and provide an overview of the ways in which these techniques are being used to characterize tumors by helping distinguish tumor types, assess tumor grade, and attempt to determine tumor margins. In addition, the role of these techniques for evaluating response to tumor therapy is outlined.

Authors
Provenzale, JM; Mukundan, S; Barboriak, DP
MLA Citation
Provenzale, JM, Mukundan, S, and Barboriak, DP. "Diffusion-weighted and perfusion MR imaging for brain tumor characterization and assessment of treatment response." Radiology 239.3 (June 2006): 632-649. (Review)
PMID
16714455
Source
pubmed
Published In
Radiology
Volume
239
Issue
3
Publish Date
2006
Start Page
632
End Page
649
DOI
10.1148/radiol.2393042031

Creation of DICOM--aware applications using ImageJ.

The demand for image-processing software for radiology applications has been increasing, fueled by advancements in both image-acquisition and image-analysis techniques. The utility of existing image-processing software is often limited by cost, lack of flexibility, and/or specific hardware requirements. In particular, many existing packages cannot directly utilize images formatted using the specifications in part 10 of the DICOM standard ("DICOM images"). We show how image analyses can be performed directly on DICOM images by using ImageJ, a free, Java-based image-processing package (http://rsb.info.nih.gov/ij/). We demonstrate how plug-ins written in our laboratory can be used along with the ImageJ macro script language to create flexible, low-cost, multiplatform image-processing applications that can be directed by information contained in the DICOM image header.

Authors
Barboriak, DP; Padua, AO; York, GE; Macfall, JR
MLA Citation
Barboriak, DP, Padua, AO, York, GE, and Macfall, JR. "Creation of DICOM--aware applications using ImageJ." J Digit Imaging 18.2 (June 2005): 91-99.
PMID
15827831
Source
pubmed
Published In
Journal of Digital Imaging
Volume
18
Issue
2
Publish Date
2005
Start Page
91
End Page
99
DOI
10.1007/s10278-004-1879-4

Dosimetry and radiographic analysis of 131I-labeled anti-tenascin 81C6 murine monoclonal antibody in newly diagnosed patients with malignant gliomas: a phase II study.

UNLABELLED: The objective was to perform dosimetry and evaluate dose-response relationships in newly diagnosed patients with malignant brain tumors treated with direct injections of (131)I-labeled anti-tenascin murine 81C6 monoclonal antibody (mAb) into surgically created resection cavities (SCRCs) followed by conventional external-beam radiotherapy and chemotherapy. METHODS: Absorbed doses to the 2-cm-thick shell, measured from the margins of the resection cavity interface, were estimated for 33 patients with primary brain tumors. MRI/SPECT registrations were used to assess the distribution of the radiolabeled mAb in brain parenchyma. Results from biopsies obtained from 15 patients were classified as tumor, radionecrosis, or tumor and radionecrosis, and these were correlated with absorbed dose and dose rate. Also, MRI/PET registrations were used to assess radiographic progression among patients. RESULTS: This therapeutic strategy yielded a median survival of 86 and 79 wk for all patients and glioblastoma multiforme (GBM) patients, respectively. The average SCRC residence time of (131)I-mu81C6 mAb was 76 h (range, 34-169 h). The average absorbed dose to the 2-cm cavity margins was 48 Gy (range, 25-116 Gy) for all patients and 51 Gy (range, 27-116 Gy) for GBM patients. In MRI/SPECT registrations, we observed a preferential distribution of (131)I-mu81C6 mAb through regions of vasogenic edema. An analysis of the relationship between the absorbed dose and dose rate and the first biopsy results yielded a most favorable absorbed dose of 44 Gy. A correlation between decreased survival and irreversible neurotoxicity was noted. A comparative analysis, in terms of median survival, was performed with previous brachytherapy clinical studies, which showed a proportional relationship between the average boost absorbed dose and the median survival. CONCLUSION: This study shows that (131)I-mu81C6 mAb increases the median survival of GBM patients. An optimal absorbed dose of 44 Gy to the 2-cm cavity margins is suggested to reduce the incidence of neurologic toxicity. Further clinical studies are warranted to determine the effectiveness of (131)I-mu81C6 mAb based on a target dose of 44 Gy rather than a fixed administered activity.

Authors
Akabani, G; Reardon, DA; Coleman, RE; Wong, TZ; Metzler, SD; Bowsher, JE; Barboriak, DP; Provenzale, JM; Greer, KL; DeLong, D; Friedman, HS; Friedman, AH; Zhao, X-G; Pegram, CN; McLendon, RE; Bigner, DD; Zalutsky, MR
MLA Citation
Akabani, G, Reardon, DA, Coleman, RE, Wong, TZ, Metzler, SD, Bowsher, JE, Barboriak, DP, Provenzale, JM, Greer, KL, DeLong, D, Friedman, HS, Friedman, AH, Zhao, X-G, Pegram, CN, McLendon, RE, Bigner, DD, and Zalutsky, MR. "Dosimetry and radiographic analysis of 131I-labeled anti-tenascin 81C6 murine monoclonal antibody in newly diagnosed patients with malignant gliomas: a phase II study." J Nucl Med 46.6 (June 2005): 1042-1051.
PMID
15937318
Source
pubmed
Published In
Journal of nuclear medicine : official publication, Society of Nuclear Medicine
Volume
46
Issue
6
Publish Date
2005
Start Page
1042
End Page
1051

Association of internal carotid artery injury with carotid canal fractures in patients with head trauma.

OBJECTIVE: The purpose of our study was to determine the degree to which carotid canal fracture and other CT findings are associated with internal carotid artery (ICA) injury in patients with head trauma. MATERIALS AND METHODS: Three neuroradiologists retrospectively evaluated CT scans and cerebral angiograms of 43 patients who underwent cerebral angiography within 7 days after blunt cranial trauma over a 5-year period. Seventeen patients underwent unilateral and 26 had bilateral carotid angiography. Angiograms were evaluated for ICA injury and CT scans were evaluated for carotid canal fracture, brain contusion, subarachnoid hemorrhage, basilar skull fracture, subdural hematoma, soft-tissue swelling, sphenoid sinus air-fluid level, and other skull fracture. We recorded the number of true-positive (+CT, +angiogram), true-negative (-CT, -angiogram), false-positive (+CT, -angiogram), and false-negative (-CT, +angiogram) studies. We determined the sensitivity, specificity, positive predictive value, and negative predictive value for each CT finding. RESULTS: We identified 21 carotid canal fractures in 17 patients. Eleven ICA injuries were seen in 10 patients. Six patients with ICA injury had a carotid canal fracture. The presence of a carotid canal fracture had a sensitivity of 60% and specificity of 67% for detection of injury to the ICA passing through that canal. These values were similar to those for other CT findings. CONCLUSION: Sensitivity, specificity, positive predictive value, and negative predictive value of carotid canal fracture were only moderately good for determining the presence of ICA injury and were similar to other CT findings not typically associated with ICA injury.

Authors
York, G; Barboriak, D; Petrella, J; DeLong, D; Provenzale, JM
MLA Citation
York, G, Barboriak, D, Petrella, J, DeLong, D, and Provenzale, JM. "Association of internal carotid artery injury with carotid canal fractures in patients with head trauma." AJR Am J Roentgenol 184.5 (May 2005): 1672-1678.
PMID
15855137
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
184
Issue
5
Publish Date
2005
Start Page
1672
End Page
1678
DOI
10.2214/ajr.184.5.01841672

Assessment of apparent diffusion coefficient in normal and degenerated intervertebral lumbar disks: initial experience.

PURPOSE: To determine prospectively the diffusibility of water in normal lumbar disks in adults by using the mean apparent diffusion coefficient (ADC) and to determine if a relationship exists between disk ADC and magnetic resonance (MR) findings of disk degeneration. MATERIALS AND METHODS: The study was approved by the Institutional Review Board, and all participants gave written informed consent prior to enrollment. Diffusion-weighted MR imaging of the lumbar spine was performed in 39 patients (all men; mean age, 53 years) and five volunteers (all men; mean age, 31 years). ADC values were recorded for each disk. All disks were visually graded by two independent observers as being normal or as showing at least one of three MR findings of degeneration on sagittal T2-weighted images. Mean ADC values of normal disks were compared with those of degenerated disks and were correlated with age and anatomic location. Data were analyzed by using Kendall correlation statistics, Mantel-Haenszel statistics, and a paired two-tailed Student t test. RESULTS: The mean ADC value was 2.27 x 10(-3) mm(2)/sec +/- 0.58 (+/- standard deviation) in normal disks and 2.06 x 10(-3) mm(2)/sec +/- 0.47 in abnormal disks (9% reduction, P = .006). A statistically significant dependence of lumbar disk ADC on anatomic location was reported (analysis of variance, P < .001), with lower ADC values seen in more caudal disks. There was no association between age and mean disk ADC. CONCLUSION: A statistically significant decrease was seen in the ADC values of degenerated lumbar disks when compared with ADC values of normal disks. More caudal disks, even when normal, showed lower ADC values than more cephalic disks.

Authors
Kealey, SM; Aho, T; Delong, D; Barboriak, DP; Provenzale, JM; Eastwood, JD
MLA Citation
Kealey, SM, Aho, T, Delong, D, Barboriak, DP, Provenzale, JM, and Eastwood, JD. "Assessment of apparent diffusion coefficient in normal and degenerated intervertebral lumbar disks: initial experience." Radiology 235.2 (May 2005): 569-574.
PMID
15798157
Source
pubmed
Published In
Radiology
Volume
235
Issue
2
Publish Date
2005
Start Page
569
End Page
574
DOI
10.1148/radiol.2352040437

A lethal association of congenital apnea with brainstem tegmental necrosis.

We present a female with premature birth, polyhydramnios, congenital apnea, cranial nerve palsies, orofacial and limb anomalies. Neuroimaging revealed calcifications along the vental margin of the caudal fourth ventricle. Neuropathologic findings at postmortem examination were consistent with brainstem tegmental necrosis and olivary hypoplasia, a rare lethal entity that should be considered in the differential diagnosis of congenital apnea.

Authors
Moya, MP; Delong, GR; Barboriak, D; Cummings, TJ
MLA Citation
Moya, MP, Delong, GR, Barboriak, D, and Cummings, TJ. "A lethal association of congenital apnea with brainstem tegmental necrosis." Pediatr Neurol 30.3 (March 2004): 219-221.
PMID
15033208
Source
pubmed
Published In
Pediatric Neurology
Volume
30
Issue
3
Publish Date
2004
Start Page
219
End Page
221
DOI
10.1016/j.pediatrneurol.2003.07.007

Correlation of early dynamic CT perfusion imaging with whole-brain MR diffusion and perfusion imaging in acute hemispheric stroke.

BACKGROUND AND PURPOSE: Compared with MR imaging, dynamic CT perfusion imaging covers only a fraction of the whole brain. An important assumption is that CT perfusion abnormalities correlate with total ischemic volume. The purpose of our study was to measure the degree of correlation between abnormalities seen on CT perfusion scans and the volumes of abnormality seen on MR diffusion and perfusion images in patients with acute large-vessel stroke. METHODS: Fourteen patients with acute hemispheric stroke symptoms less than 12 hours in duration were studied with single-slice CT perfusion imaging and multislice MR diffusion and perfusion imaging. CT and MR perfusion studies were completed within 2.5 hours of one another (mean, 77 minutes) and were reviewed independently by two neuroradiologists. Hemodynamic parameters included cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT). Extents of abnormality on images were compared by using Kendall correlation. RESULTS: Statistically significant correlation was found between CT-CBF and MR-CBF abnormalities (tau = 0.60, P =.003) and CT-MTT and MR-MTT abnormalities (tau = 0.65, P =.001). Correlation of CT-CBV with MR-CBV approached significance (tau = 0.39, P =.06). Extent of initial hyperintensity on diffusion-weighted images correlated best with extent of MR-CBV abnormality (tau = 0.69, P =.001), extent of MR-MTT abnormality (tau = 0.67, P =.002), and extent of CT-CBV abnormality (tau = 0.47, P =.02). CONCLUSION: Good correlation was seen between CT and MR for CBF and MTT abnormalities. It remains uncertain whether CT perfusion CBV abnormalities correspond well to whole-brain abnormalities.

Authors
Eastwood, JD; Lev, MH; Wintermark, M; Fitzek, C; Barboriak, DP; Delong, DM; Lee, T-Y; Azhari, T; Herzau, M; Chilukuri, VR; Provenzale, JM
MLA Citation
Eastwood, JD, Lev, MH, Wintermark, M, Fitzek, C, Barboriak, DP, Delong, DM, Lee, T-Y, Azhari, T, Herzau, M, Chilukuri, VR, and Provenzale, JM. "Correlation of early dynamic CT perfusion imaging with whole-brain MR diffusion and perfusion imaging in acute hemispheric stroke." AJNR Am J Neuroradiol 24.9 (October 2003): 1869-1875.
PMID
14561618
Source
pubmed
Published In
American Journal of Neuroradiology
Volume
24
Issue
9
Publish Date
2003
Start Page
1869
End Page
1875

Imaging of brain tumors with diffusion-weighted and diffusion tensor MR imaging.

The advent of diffusion-weighted MR imaging and diffusion tensor MR imaging has had little impact on brain tumor detection. Diffusion-weighted imaging has been effective in characterizing specific types of masses, particularly in distinguishing epidermoids from arachnoid cysts, and cystic tumors from intracerebral abscesses. Presurgical planning using tractography with diffusion tensor MR imaging, and perhaps the evaluation of tumor response to chemotherapy and radiation therapy with diffusion-weighted imaging, may become important applications in the near future.

Authors
Barboriak, DP
MLA Citation
Barboriak, DP. "Imaging of brain tumors with diffusion-weighted and diffusion tensor MR imaging." Magn Reson Imaging Clin N Am 11.3 (August 2003): 379-401. (Review)
PMID
14768725
Source
pubmed
Published In
Magnetic Resonance Imaging Clinics of North America
Volume
11
Issue
3
Publish Date
2003
Start Page
379
End Page
401

Screening for cerebral metastases with FDG PET in patients undergoing whole-body staging of non-central nervous system malignancy.

PURPOSE: To compare fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) with the current standard, magnetic resonance (MR) imaging, to determine the sensitivity and specificity of FDG PET for detection of cerebral metastases and to determine the factors that may affect lesion conspicuity. MATERIALS AND METHODS: Forty patients underwent brain PET and contrast material-enhanced brain MR imaging, with a maximum of 30 days between examinations. PET and MR images were each retrospectively reviewed by two independent readers who were blinded to the clinical history and results of the other technique. Presence of metastatic disease was recorded for each modality. Sensitivity and specificity of FDG PET were determined with MR imaging as the standard. Statistical analysis was performed with the Fisher exact test and the logistic regression model. RESULTS: Sixteen patients had cerebral metastases at MR imaging, and in 12 of these, PET scans were interpreted as showing metastatic disease (in four, scans were false-negative). Twenty-four patients had no cerebral metastases at MR imaging, and 20 of these had PET scans interpreted as normal (in four, scans were false-positive). For identification of patients with cerebral metastases, FDG PET had a sensitivity of 75% (12 of 16) and a specificity of 83% (20 of 24). Thirty-eight metastatic lesions were seen at MR imaging; 23 (61%) of these were identified at PET. Size was a statistically significant factor that influenced lesion detection at PET (P <.001). CONCLUSION: Only 61% of metastatic lesions in the brain were identified at PET. In particular, detection of small lesions was difficult.

Authors
Rohren, EM; Provenzale, JM; Barboriak, DP; Coleman, RE
MLA Citation
Rohren, EM, Provenzale, JM, Barboriak, DP, and Coleman, RE. "Screening for cerebral metastases with FDG PET in patients undergoing whole-body staging of non-central nervous system malignancy." Radiology 226.1 (January 2003): 181-187.
PMID
12511688
Source
pubmed
Published In
Radiology
Volume
226
Issue
1
Publish Date
2003
Start Page
181
End Page
187
DOI
10.1148/radiol.2261010920

MR signal intensity of gray matter/white matter contrast and intracranial fat: effects of age and sex.

Signal intensity (SI) values of gray- and white-matter brain regions of interest (ROIs) were obtained from T(2)- and proton density-weighted magnetic resonance (MR) images of 58 normal subjects aged 22-82 years (31 females, 52.3+/-18.8 years; 27 males, 54.1+/-18.1 years). Sampled ROIs included the caudate, putamen, thalamus, orbitofrontal gyrus, gyrus rectus, uncus, frontal white matter, anterior and posterior corpus callosum, cranial-cervical junction fat, and retroorbital fat. Effects of age and sex on SI were examined using repeated-measures analysis of covariance. For both T(2)- and proton density-weighted acquisitions, a significant inverse relationship between age and SI was observed for the ratio of all summed gray-matter ROIs divided by summed white-matter ROIs. This relationship was additionally observed for ratios of both subcortical gray/white matter and cortical gray/white matter. Females compared with males had significantly lower cortical gray/white matter ratios on T(2)-weighted scans. Differences in SI were observed between cranial-cervical junction fat and retroorbital fat on both acquisitions, with females showing significantly higher values for cranial-cervical junction fat and males showing higher values for retroorbital fat. Implications for brain morphometry, the use of fat as a reference standard, and other issues in neuroimaging are discussed.

Authors
Kim, DM; Xanthakos, SA; Tupler, LA; Barboriak, DP; Charles, HC; MacFall, JR; Krishnan, KRR
MLA Citation
Kim, DM, Xanthakos, SA, Tupler, LA, Barboriak, DP, Charles, HC, MacFall, JR, and Krishnan, KRR. "MR signal intensity of gray matter/white matter contrast and intracranial fat: effects of age and sex." Psychiatry Res 114.3 (July 1, 2002): 149-161.
PMID
12113897
Source
pubmed
Published In
Psychiatry Research
Volume
114
Issue
3
Publish Date
2002
Start Page
149
End Page
161

Evaluation of software for registration of contrast-enhanced brain MR images in patients with glioblastoma multiforme.

OBJECTIVE: We evaluated commercially available software that rapidly and automatically registers brain MR images on a clinical workstation, and we studied the accuracy of these registrations. SUBJECTS AND METHODS: Ten patients with a diagnosis of glioblastoma multiforme underwent contrast-enhanced inversion recovery prepared three-dimensional (3D) volumetric spoiled gradient-recalled acquisition in the steady state (SPGR) MR imaging (contiguous 1.5-mm slice thickness, 96-104 slices). After this imaging sequence, each patient was brought out of the head coil into a sitting position and then repositioned in the coil. The inversion recovery prepared 3D SPGR sequence was then repeated. A commercially available software program operating on a clinical workstation was used to automatically register the second inversion recovery prepared SPGR series to the first. The speed of registration was recorded. The accuracy of each registration was estimated by recording the coordinates of eight anatomic landmarks on the registered and reference series and by calculating the mean error among matching landmarks. RESULTS: In nine of 10 patients, the registration software produced a visually satisfactory registration. In one patient, a second registration was necessary to produce a satisfactory registration. The processing time for each iteration was 48.3 +/- 3.8 sec (mean +/- SD). The mean error in aligning matching anatomic landmarks ranged from 0.67 to 1.41 mm, with an overall mean of 1.18 mm. The largest error among matching landmarks was 2.3 mm. CONCLUSION: Commercially available registration software can automatically register 3D imaging volumes in less than 1 min. The mean error in registration was approximately equivalent to the dimensions of a single voxel.

Authors
Barboriak, DP; Provenzale, JM
MLA Citation
Barboriak, DP, and Provenzale, JM. "Evaluation of software for registration of contrast-enhanced brain MR images in patients with glioblastoma multiforme." AJR Am J Roentgenol 179.1 (July 2002): 245-250.
PMID
12076945
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
179
Issue
1
Publish Date
2002
Start Page
245
End Page
250
DOI
10.2214/ajr.179.1.1790245

Assessment of registered serial post-contrast 3D SPGR volumetric MR imaging for evaluation of changes in brain tumors

Authors
Barboriak, DP; Eastwood, JD; Barboriak, CG; Provenzale, JM
MLA Citation
Barboriak, DP, Eastwood, JD, Barboriak, CG, and Provenzale, JM. "Assessment of registered serial post-contrast 3D SPGR volumetric MR imaging for evaluation of changes in brain tumors." RADIOLOGY 222.2 (February 2002): 591-591.
Source
wos-lite
Published In
Radiology
Volume
222
Issue
2
Publish Date
2002
Start Page
591
End Page
591

CT perfusion scanning with deconvolution analysis: pilot study in patients with acute middle cerebral artery stroke.

PURPOSE: To measure mean cerebral blood flow (CBF) in ischemic and nonischemic territories and in low-attenuation regions in patients with acute stroke by using deconvolution-derived hemodynamic imaging. MATERIALS AND METHODS: Twelve patients with acute middle cerebral artery stroke and 12 control patients were examined by using single-section computed tomography (CT) perfusion scanning. Analysis was performed with a deconvolution-based algorithm. Comparisons of mean CBF, cerebral blood volume (CBV), and mean transit time (MTT) were determined between hemispheres in all patients and between low- and normal-attenuation regions in patients with acute stroke. Two independent readers examined the images for extent of visually apparent regional perfusion abnormalities. The data were compared with extent of final infarct in seven patients with acute stroke who underwent follow-up CT or magnetic resonance imaging. RESULTS: Significant decreases in CBF (-50%, P =.001) were found in the affected hemispheres of patients with acute stroke. Significant changes in CBV (-26%, P =.03) and MTT (+111%, P =.004) were also seen. Significant alterations in perfusion were also seen in low- compared with normal-attenuation areas. Pearson correlation between readers for extent of CBF abnormality was 0.94 (P =.001). Intraobserver variation was 8.9% for CBF abnormalities. CONCLUSION: Deconvolution analysis of CT perfusion data is a promising method for evaluation of cerebral hemodynamics in patients with acute stroke.

Authors
Eastwood, JD; Lev, MH; Azhari, T; Lee, T-Y; Barboriak, DP; Delong, DM; Fitzek, C; Herzau, M; Wintermark, M; Meuli, R; Brazier, D; Provenzale, JM
MLA Citation
Eastwood, JD, Lev, MH, Azhari, T, Lee, T-Y, Barboriak, DP, Delong, DM, Fitzek, C, Herzau, M, Wintermark, M, Meuli, R, Brazier, D, and Provenzale, JM. "CT perfusion scanning with deconvolution analysis: pilot study in patients with acute middle cerebral artery stroke." Radiology 222.1 (January 2002): 227-236.
PMID
11756730
Source
pubmed
Published In
Radiology
Volume
222
Issue
1
Publish Date
2002
Start Page
227
End Page
236
DOI
10.1148/radiol.2221010471

Do prolonged febrile seizures produce medial temporal sclerosis? Hypotheses, MRI evidence and unanswered questions.

Whether or not severe febrile seizures in infancy cause hippocampal injury and subsequent medial temporal sclerosis is an often debated question in epilepsy. Recent magnetic resonance imaging (MRI) of infants suffering from febrile seizures has provided preliminary evidence that abnormally increased T2 signal intensity can be seen in the hippocampi of infants following prolonged and focal febrile seizures. Follow-up MRIs in a few of these infants have confirmed that medial temporal sclerosis can develop following these acute MRI signal changes. In this article, we review the hypotheses and MRI evidence relating to hippocampal injury during prolonged febrile seizures and the later development of medial temporal sclerosis.

Authors
Lewis, DV; Barboriak, DP; MacFall, JR; Provenzale, JM; Mitchell, TV; VanLandingham, KE
MLA Citation
Lewis, DV, Barboriak, DP, MacFall, JR, Provenzale, JM, Mitchell, TV, and VanLandingham, KE. "Do prolonged febrile seizures produce medial temporal sclerosis? Hypotheses, MRI evidence and unanswered questions." Prog Brain Res 135 (2002): 263-278. (Review)
PMID
12143347
Source
pubmed
Published In
Progress in Brain Research
Volume
135
Publish Date
2002
Start Page
263
End Page
278

Learning and recall in subjects at genetic risk for Alzheimer's disease.

Deficits in delayed recall of learned information may be an early marker of Alzheimer's disease (AD). The apolipoprotein E E4 allele and a positive family history (FH) are both genetic risk factors for AD. The authors cross-sectionally compared performance on the California Verbal Learning Test (CVLT) in 153 prospectively recruited normal elderly subjects (mean age 67 years, mean MMSE=28) stratified by genetic risk into four groups (E4+/FH+, E4+/FH-, E4-/FH+, E4-/FH-). Neither FH nor E4 status affected performance, except on List B (a distraction word list), on which the FH+ group performed worse. The high-risk group (E4+/FH+) also performed worse on List B than the low-risk group (E4-/FH-) but did not differ on other measures. Memory impairments associated with genetic or family history risk may not manifest until the person is much closer to the onset age of AD.

Authors
Chen, JG; Edwards, CL; Vidyarthi, S; Pitchumoni, S; Tabrizi, S; Barboriak, D; Charles, HC; Doraiswamy, PM
MLA Citation
Chen, JG, Edwards, CL, Vidyarthi, S, Pitchumoni, S, Tabrizi, S, Barboriak, D, Charles, HC, and Doraiswamy, PM. "Learning and recall in subjects at genetic risk for Alzheimer's disease." J Neuropsychiatry Clin Neurosci 14.1 (2002): 58-63.
PMID
11884656
Source
pubmed
Published In
The Journal of neuropsychiatry and clinical neurosciences
Volume
14
Issue
1
Publish Date
2002
Start Page
58
End Page
63
DOI
10.1176/jnp.14.1.58

Quantitative assessment of diffusion abnormalities in posterior reversible encephalopathy syndrome.

BACKGROUND AND PURPOSE: Previous studies have shown that lesions in posterior reversible encephalopathy syndrome are often isointense on diffusion-weighted MR images. We hypothesized that 1) apparent diffusion coefficient (ADC) maps using various thresholds would show larger abnormalities in posterior white matter (WM) and 2) isointense appearance of lesions on isotropic diffusion-weighted images results from a balance of T2 prolongation effects and diffusibility effects. METHODS: T2-weighted MR images from 11 patients were reviewed. Hyperintense lesions were located in both anterior and posterior WM in eight patients and solely in posterior WM in three patients. The ADC maps were produced by use of ADC values > or = 3 SD and > or = 10 SD above the mean value of normal WM. Lesions on diffusion-weighted images were classified as isointense or hypointense. ADC values within lesions (ADC(L)) were compared with those of normal WM (ADC(N)), and compared for isointense lesions and hypointense lesions. RESULTS: The distribution of lesions with ADC values > or = 3 SD was essentially identical to that on T2-weighted images. Regions with ADC values > or = 10 SD were found in both anterior WM and posterior WM in two patients and solely in posterior WM in nine patients. On diffusion-weighted images, lesions appeared isointense in seven patients and hypointense in four patients. Mean ADC(L)/ADC(N) for all lesions was 1.81; for hypointense lesions, 2.30. CONCLUSION: Vasogenic edema was more severe in posterior WM. Isointense lesions result from a balance of T2 effects and increased water diffusibility. Hypointense lesions have higher ADC values, which are not balanced by T2 effects.

Authors
Provenzale, JM; Petrella, JR; Cruz, LC; Wong, JC; Engelter, S; Barboriak, DP
MLA Citation
Provenzale, JM, Petrella, JR, Cruz, LC, Wong, JC, Engelter, S, and Barboriak, DP. "Quantitative assessment of diffusion abnormalities in posterior reversible encephalopathy syndrome." AJNR Am J Neuroradiol 22.8 (September 2001): 1455-1461.
PMID
11559490
Source
pubmed
Published In
American Journal of Neuroradiology
Volume
22
Issue
8
Publish Date
2001
Start Page
1455
End Page
1461

Serial MR imaging of pineal cysts: implications for natural history and follow-up.

OBJECTIVE: The purpose of this study was to examine the frequency of change in size of pineal cysts on serial MR studies. MATERIALS AND METHODS: Thirty-two patients (19 females, 13 males) with a diagnosis of pineal cyst at any time who underwent brain MR imaging more than once in a period of at least 6 months were identified by computerized search of radiology reports. Four patients underwent MR imaging to follow up pineal cysts, whereas the remaining patients were imaged for a variety of indications, including intracerebral neoplasms. Measurements of maximal cyst dimension on both initial and latest follow-up studies were obtained in all patients, and cyst volumes were calculated in 23 patients. RESULTS: Length of follow-up ranged from 6 months to 9 years. All cysts were considered incidental and none were treated. Maximal cyst dimensions ranged from 0.5 to 2.2 cm. On average, there was no significant change in cyst volume. The maximal dimension of the cyst did not change in 24 (75%) of 32 patients. Two cysts resolved completely on follow-up, three cysts decreased by 2-4 mm, two cysts enlarged by 2-3 mm, and one cyst formed and grew to 1.2 cm. CONCLUSION: Whereas the size of pineal cysts as a whole remained unchanged on serial MR studies, cysts may either form or involute in individual patients. Small increases in cyst size did occur but were not associated with specific clinical findings. These findings suggest that typical pineal cysts may be followed up on a clinical basis alone rather than on imaging.

Authors
Barboriak, DP; Lee, L; Provenzale, JM
MLA Citation
Barboriak, DP, Lee, L, and Provenzale, JM. "Serial MR imaging of pineal cysts: implications for natural history and follow-up." AJR Am J Roentgenol 176.3 (March 2001): 737-743.
PMID
11222216
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
176
Issue
3
Publish Date
2001
Start Page
737
End Page
743
DOI
10.2214/ajr.176.3.1760737

Vertex epidural hematomas: imaging findings and diagnostic pitfalls.

PURPOSE: Our purpose was to show the computed tomography (CT) and magnetic resonance (MR) imaging features of vertex epidural hematomas (EDHs) and emphasize pitfalls in the diagnosis of this entity. SUBJECTS AND METHODS: The neuroradiologic studies of four patients (CT in four, MR imaging and MR venography in one) were evaluated for EDH shape, size and appearance. RESULTS: EDHs were biconvex in three patients and crescentic in one patient. CT appearances included a collection that was hyperdense (two patients), generally isodense with a few regions of hyperdensity (one patient) and mixed hyperdense and hypodense (one patient). MR imaging findings in one patient consisted of hyperintense signal on T1-weighted images and hypointense signal on T2-weighted images. Inferior displacement of the superior sagittal sinus was seen in two patients. Diagnosis of a small vertex EDH was difficult on routine axial CT in one patient, but apparent on MR imaging and MR venography. CONCLUSIONS: Small vertex EDHs can be difficult to diagnose on routine CT. MR imaging or thin section CT should be performed to exclude the diagnosis in patients with trauma to the skull vertex.

Authors
Harbury, OL; Provenzale, JM; Barboriak, DP
MLA Citation
Harbury, OL, Provenzale, JM, and Barboriak, DP. "Vertex epidural hematomas: imaging findings and diagnostic pitfalls." Eur J Radiol 36.3 (December 2000): 150-157.
PMID
11091016
Source
pubmed
Published In
European Journal of Radiology
Volume
36
Issue
3
Publish Date
2000
Start Page
150
End Page
157

Effect of intracavitary radiation therapy for cerebral gliomas on relative cerebral blood volume in adjacent white matter: Assessment with perfusion MR imaging

Authors
Barboriak, DP; Holmes, TM; Less, CG; Coleman, RE; Friedman, HS; Provenzale, JM
MLA Citation
Barboriak, DP, Holmes, TM, Less, CG, Coleman, RE, Friedman, HS, and Provenzale, JM. "Effect of intracavitary radiation therapy for cerebral gliomas on relative cerebral blood volume in adjacent white matter: Assessment with perfusion MR imaging." RADIOLOGY 217 (November 2000): 297-298.
Source
wos-lite
Published In
Radiology
Volume
217
Publish Date
2000
Start Page
297
End Page
298

Detection of cerebral metastases by FDG imaging and MRI

Authors
Rohren, EM; Barboriak, DP; Coleman, RE; Provenzale, JM
MLA Citation
Rohren, EM, Barboriak, DP, Coleman, RE, and Provenzale, JM. "Detection of cerebral metastases by FDG imaging and MRI." RADIOLOGY 217 (November 2000): 498-498.
Source
wos-lite
Published In
Radiology
Volume
217
Publish Date
2000
Start Page
498
End Page
498

Hippocampal sulcal cavities on MRI: relationship to age and apolipoprotein E genotype.

Hippocampal sulcal cavities are usually considered incidental findings on brain MRI. In a group of 92 elderly volunteers, the authors graded the number and size of hippocampal sulcal cavities with brain MRI to obtain a cavity score. Cavity scores increased with age, and were higher in subjects carrying the APOE epsilon4 or epsilon2 alleles than in subjects with the epsilon3/3 genotype. Age-related morphologic changes in the hippocampus may be mediated by the APOE genotype.

Authors
Barboriak, DP; Doraiswamy, PM; Krishnan, KR; Vidyarthi, S; Sylvester, J; Charles, HC
MLA Citation
Barboriak, DP, Doraiswamy, PM, Krishnan, KR, Vidyarthi, S, Sylvester, J, and Charles, HC. "Hippocampal sulcal cavities on MRI: relationship to age and apolipoprotein E genotype." Neurology 54.11 (June 13, 2000): 2150-2153.
PMID
10851380
Source
pubmed
Published In
Neurology
Volume
54
Issue
11
Publish Date
2000
Start Page
2150
End Page
2153

Comparison of patient age with MR imaging features of gangliogliomas.

OBJECTIVE: The purpose of this study was to compare MR imaging features of gangliogliomas in children less than 10 years old with those seen in patients at least 10 years old. MATERIALS AND METHODS: Our study population consisted of 15 female patients and 10 male patients with a mean age of 20 years. The early childhood group was composed of six children with a mean age of 5.5 years. The older group was composed of 19 patients with a mean age of 25.6 years. We assessed tumor volume, tumor location, percentage of tumor that was cystic, pattern of contrast enhancement, and degree of edema. RESULTS: The temporal lobe was the most common tumor location in both groups. Mean tumor volume in the early childhood group was 83 cm3, which was significantly larger than the mean tumor volume (9.78 cm3) for the older group (p = 0.001). Cystic tumors were more common in the early childhood group (83%) than in the older group (63%), and the average percentage of cysts in the cystic tumors was much higher in the early childhood group (67%) than in the older group (30%). Contrast enhancement was seen in five of six early childhood tumors and 13 of 16 tumors in older patients. Four of six tumors in the early childhood group and five of 19 tumors in the older patient group had associated edema. CONCLUSION: The mean tumor volume of gangliogliomas in the early childhood group was significantly larger than that of the older patient group. This finding may be indicative of differences in tumor growth patterns in the two groups, ability of the hemicranium to adjust to mass effect in childhood, or sampling error as a result of a relatively small sample size.

Authors
Provenzale, JM; Ali, U; Barboriak, DP; Kallmes, DF; Delong, DM; McLendon, RE
MLA Citation
Provenzale, JM, Ali, U, Barboriak, DP, Kallmes, DF, Delong, DM, and McLendon, RE. "Comparison of patient age with MR imaging features of gangliogliomas." AJR Am J Roentgenol 174.3 (March 2000): 859-862.
PMID
10701639
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
174
Issue
3
Publish Date
2000
Start Page
859
End Page
862
DOI
10.2214/ajr.174.3.1740859

Magnetic resonance spectroscopy in Alzheimer's disease: focus on N-acetylaspartate.

This paper reviews published post-mortem brain and in-vivo proton magnetic resonance spectroscopy (1H-MRS) studies in Alzheimer's disease (AD) and focuses on the emerging role of N-acetylaspartate (NAA) as a prognostic marker of neuronal function. Post-mortem brain studies have reported significantly lower NAA levels in AD brains than in control brains, and some have correlated the low levels with neuropathological findings (i.e. amyloid plaques and neurofibrillary tangles). Similarly, almost all published in-vivo studies have reported lower NAA levels in AD patients compared to elderly controls. While some studies have found changes in metabolite levels that were considered useful for the diagnosis of AD, most have found that 1H-MRS provided little or no advantages over other, more common diagnostic tools. Instead, recent studies in AD and other neuropsychiatric disorders suggest that NAA may be more useful as a prognostic marker for monitoring neurodegeneration, stabilization, or improvement, and for evaluating therapeutic response to novel drugs.

Authors
Chen, JG; Charles, HC; Barboriak, DP; Doraiswamy, PM
MLA Citation
Chen, JG, Charles, HC, Barboriak, DP, and Doraiswamy, PM. "Magnetic resonance spectroscopy in Alzheimer's disease: focus on N-acetylaspartate." Acta Neurol Scand Suppl 176 (2000): 20-26. (Review)
PMID
11261801
Source
pubmed
Published In
Acta Neurologica Scandinavica, Supplement
Volume
176
Publish Date
2000
Start Page
20
End Page
26

Measurement of apparent diffusion coefficients in human brain: Comparison of three-direction isotropic and six-direction tensor methods

Authors
Barboriak, DP; Petrella, JR; Wong, J; Ott, KC; Provenzale, JM; MacFall, JR
MLA Citation
Barboriak, DP, Petrella, JR, Wong, J, Ott, KC, Provenzale, JM, and MacFall, JR. "Measurement of apparent diffusion coefficients in human brain: Comparison of three-direction isotropic and six-direction tensor methods." RADIOLOGY 213P (November 1999): 274-274.
Source
wos-lite
Published In
Radiology
Volume
213P
Publish Date
1999
Start Page
274
End Page
274

White matter lesion contrast in fast spin-echo fluid-attenuated inversion recovery imaging: effect of varying effective echo time and echo train length.

OBJECTIVE: Our aim was to determine whether the contrast between white matter lesions and normal-appearing white matter in fast spin-echo fluid-attenuated inversion recovery (FLAIR) images can be improved by lengthening the effective TE and the echo train length. SUBJECTS AND METHODS: Thirty patients with various white matter lesions were imaged using fast spin-echo FLAIR sequences (TR = 10,002 msec; inversion time = 2200) on a 1.5-T MR imaging system. For 14 patients, fast spin-echo FLAIR sequences with a TE of 165 msec and echo train length of 32 (fast spin-echo FLAIR 165/32) were compared with fast spin-echo FLAIR sequences with a TE of 125 msec and echo train length of 24 (fast spin-echo FLAIR 125/24). For 16 other patients, fast spin-echo FLAIR 165/32 sequences were compared with fast spin-echo FLAIR sequences with a TE of 145 msec and echo train length of 28 (fast spin-echo FLAIR 145/28). Signal difference-to-noise ratios were calculated between the lesions and normal-appearing white matter for a typical lesion in each patient. RESULTS: In both groups, a small but statistically significant increase in the signal difference-to-noise ratio was found on the fast spin-echo FLAIR sequences using the longer TE and echo train length. In the first group, signal difference-to-noise ratio increased from 18.7 +/- 4.7 (mean +/- SD) for fast spin-echo FLAIR 125/24 to 20.1 +/- 4.5 for fast spin-echo FLAIR 165/32 (p < .05). In the second group, the signal difference-to-noise ratio increased from 15.4 +/- 4.0 for fast spin-echo FLAIR 145/28 to 16.8 +/- 4.6 for fast spin-echo FLAIR 165/32 (p <.01). In addition, fast spin-echo FLAIR sequences with a longer TE and echo train length were obtained more rapidly (6 min for fast spin-echo FLAIR 125/24, 5 min 20 sec for fast spin-echo FLAIR 145/28, and 4 min 41 sec for fast spin-echo FLAIR 165/32). CONCLUSION: Lengthening the TE to 165 msec and echo train length to 32 in fast spin-echo FLAIR imaging allows both a mild improvement in the contrast between white matter lesions and normal-appearing white matter and shorter imaging times.

Authors
Barboriak, DP; Provenzale, JM; MacFall, JR
MLA Citation
Barboriak, DP, Provenzale, JM, and MacFall, JR. "White matter lesion contrast in fast spin-echo fluid-attenuated inversion recovery imaging: effect of varying effective echo time and echo train length." AJR Am J Roentgenol 173.4 (October 1999): 1091-1096.
PMID
10511185
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
173
Issue
4
Publish Date
1999
Start Page
1091
End Page
1096
DOI
10.2214/ajr.173.4.10511185

MR arteriography of intracranial circulation.

Authors
Barboriak, DP; Provenzale, JM
MLA Citation
Barboriak, DP, and Provenzale, JM. "MR arteriography of intracranial circulation." AJR Am J Roentgenol 171.6 (December 1998): 1469-1478. (Review)
PMID
9843273
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
171
Issue
6
Publish Date
1998
Start Page
1469
End Page
1478
DOI
10.2214/ajr.171.6.9843273

Limbic encephalitis: comparison of FDG PET and MR imaging findings.

Authors
Provenzale, JM; Barboriak, DP; Coleman, RE
MLA Citation
Provenzale, JM, Barboriak, DP, and Coleman, RE. "Limbic encephalitis: comparison of FDG PET and MR imaging findings." AJR Am J Roentgenol 170.6 (June 1998): 1659-1660.
PMID
9609193
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
170
Issue
6
Publish Date
1998
Start Page
1659
End Page
1660
DOI
10.2214/ajr.170.6.9609193

Cerebrovascular disease risk factors: neuroradiologic findings in patients with activated protein C resistance.

PURPOSE: To assess the patterns of abnormal neuroradiologic findings in patients with a hypercoagulable state related to activated protein C (APC) resistance. MATERIALS AND METHODS: Records in 23 patients with a hypercoagulable state related to APC resistance (18 women, five men; average age, 44.5 years) were reviewed for cerebrovascular disease risk factors and other causes of a hypercoagulable state. Computed tomographic scans, magnetic resonance (MR) images, angiograms, and transesophageal echocardiograms were also reviewed. RESULTS: Stroke risk factors or other causes of a hypercoagulable state were found in 12 patients. Arterial infarcts were seen in 18 patients. Hyperintense white matter foci were seen on MR images in six patients. Dural sinus thrombosis was found in four patients. Angiograms of intracranial circulation in six patients showed major artery occlusions in four. MR angiograms in four patients showed internal carotid artery occlusion in one. No major abnormalities were seen in extracranial cerebral vasculature in 15 patients. Transesophageal echocardiograms in 11 patients showed a patent foramen ovale in one patient but no systemic source of embolism. Seven patients had non-central nervous system thrombotic events. CONCLUSION: Patients with APC resistance and stroke appear to differ from the general stroke population in terms of age and frequency of extracranial sources of cerebrovascular disease.

Authors
Provenzale, JM; Barboriak, DP; Davey, IC; Ortel, TL
MLA Citation
Provenzale, JM, Barboriak, DP, Davey, IC, and Ortel, TL. "Cerebrovascular disease risk factors: neuroradiologic findings in patients with activated protein C resistance." Radiology 207.1 (April 1998): 85-89.
PMID
9530303
Source
pubmed
Published In
Radiology
Volume
207
Issue
1
Publish Date
1998
Start Page
85
End Page
89
DOI
10.1148/radiology.207.1.9530303

Antiphospholipid antibodies: findings at arteriography.

PURPOSE: The purpose of this study was to determine the frequency and types of abnormalities at arteriography in patients with antiphospholipid antibodies (APA) and ischemic cerebrovascular events. METHODS: Twenty-three patients with APA and ischemic cerebrovascular events who underwent arteriography were identified. Patients over the age of 65 years were excluded. No patients met diagnostic criteria for systemic lupus erythematosus. All angiograms were reviewed by two neuroradiologists. RESULTS: Seventeen patients (74%) between the ages of 28 and 64 years (average age, 40 years) had abnormal angiograms. Sixteen patients had arterial abnormalities and one had dural sinus thrombosis. Ten had solely intracranial abnormalities (nine arterial and one venous), six had solely extracranial arterial abnormalities, and one had both intracranial and extracranial arterial abnormalities. Intracranial arterial abnormalities included stem or branch occlusions of the cerebral or basilar arteries, which were generally solitary (six patients), and findings suggestive of vasculitis (four patients). Four patients had stenoses of the origins of two or more great vessels. Two patients had extracranial internal carotid artery stenoses or occlusions that were not typical of atheromatous disease, considered to be embolic in one patient. In another patient, a stenosis of the origin of the internal carotid artery was present that appeared typical of atheromatous disease. Infarctions were seen on CT or MR studies in 13 of 17 patients with abnormal angiograms. CONCLUSION: In our group of patients, typical atheromatous lesions at the common carotid artery bifurcation were rare. Some lesions that are infrequent in the general stroke population (eg, vasculitis-like findings and stenoses at the origin of great vessels) were common. Patients with APA and cerebrovascular events appear to differ from the general stroke population with regard to types of arterial abnormalities seen at arteriography.

Authors
Provenzale, JM; Barboriak, DP; Allen, NB; Ortel, TL
MLA Citation
Provenzale, JM, Barboriak, DP, Allen, NB, and Ortel, TL. "Antiphospholipid antibodies: findings at arteriography." AJNR Am J Neuroradiol 19.4 (April 1998): 611-616.
PMID
9576644
Source
pubmed
Published In
American Journal of Neuroradiology
Volume
19
Issue
4
Publish Date
1998
Start Page
611
End Page
616

Dural sinus thrombosis: findings on CT and MR imaging and diagnostic pitfalls.

Authors
Provenzale, JM; Joseph, GJ; Barboriak, DP
MLA Citation
Provenzale, JM, Joseph, GJ, and Barboriak, DP. "Dural sinus thrombosis: findings on CT and MR imaging and diagnostic pitfalls." AJR Am J Roentgenol 170.3 (March 1998): 777-783.
PMID
9490973
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
170
Issue
3
Publish Date
1998
Start Page
777
End Page
783
DOI
10.2214/ajr.170.3.9490973

Dural sinus thrombosis associated with activated protein C resistance: MR imaging findings and proband identification.

OBJECTIVE: The purpose of this study was to report the association of dural sinus thrombosis with a hypercoagulable state associated with activated protein C resistance. CONCLUSION: In our small study population, hemorrhagic venous infarction was common (three of four patients) among patients with dural sinus thrombosis and activated protein C resistance. Four of five patients with dural sinus thrombosis had positive tests for activated protein C resistance. This finding, in conjunction with data from other studies, suggests that patients with dural sinus thrombosis may need to be studied for the presence of activated protein C resistance. A positive finding for activated protein C resistance can be important not only in helping to explain the cause of thrombosis in affected individuals but also in identifying families at risk for thrombosis.

Authors
Provenzale, JM; Barboriak, DP; Ortel, TL
MLA Citation
Provenzale, JM, Barboriak, DP, and Ortel, TL. "Dural sinus thrombosis associated with activated protein C resistance: MR imaging findings and proband identification." AJR Am J Roentgenol 170.2 (February 1998): 499-502.
PMID
9456973
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
170
Issue
2
Publish Date
1998
Start Page
499
End Page
502
DOI
10.2214/ajr.170.2.9456973

Brain CT and MR imaging findings in patients with activated protein C resistance

Authors
Provenzale, JM; Barboriak, DP; Davey, IC; Ortel, TL
MLA Citation
Provenzale, JM, Barboriak, DP, Davey, IC, and Ortel, TL. "Brain CT and MR imaging findings in patients with activated protein C resistance." RADIOLOGY 205 (November 1997): 797-797.
Source
wos-lite
Published In
Radiology
Volume
205
Publish Date
1997
Start Page
797
End Page
797

Brain infarction in young adults: etiology and imaging findings.

The causes of stroke in young adults differ substantially from those in older adults. In many instances, the diagnosis can be made by taking a clinical history and performing laboratory studies (e.g., in patients who have multiple thromboses associated with anti-phospholipid antibodies). In other circumstances, clues to the diagnosis can be found on routine CT and MR studies. However, in many circumstances, imaging tailored to a specific diagnosis is important (e.g., MR imaging of the neck in patients with suspected arterial dissection). In yet other cases, additional studies (e.g., echocardiography in suspected cardiogenic embolism) are important to establish the cause.

Authors
Provenzale, JM; Barboriak, DP
MLA Citation
Provenzale, JM, and Barboriak, DP. "Brain infarction in young adults: etiology and imaging findings." AJR Am J Roentgenol 169.4 (October 1997): 1161-1168. (Review)
PMID
9308483
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
169
Issue
4
Publish Date
1997
Start Page
1161
End Page
1168
DOI
10.2214/ajr.169.4.9308483

Pictorial review: magnetic resonance angiography of arterial variants at the Circle of Willis.

As intracranial MR angiography becomes more widely used and spatial resolution improves, anomalies at the Circle of Willis which have been previously well described on angiographic studies and anatomic dissections will become more frequently appreciated by MR angiography. Recognition of these variants is important to avoid confusion of the anomalies with aneurysms, evaluate collateral pathways in the intracerebral circulation, and enhance pre-operative planning in patients undergoing surgery at the skull base. In this review, we illustrate several of the more common types of anomalies at the Circle of Willis and discuss the possible clinical significance of each.

Authors
Barboriak, DP; Provenzale, JM
MLA Citation
Barboriak, DP, and Provenzale, JM. "Pictorial review: magnetic resonance angiography of arterial variants at the Circle of Willis." Clin Radiol 52.6 (June 1997): 429-436. (Review)
PMID
9202585
Source
pubmed
Published In
Clinical Radiology
Volume
52
Issue
6
Publish Date
1997
Start Page
429
End Page
436

Pictorial review: Magnetic resonance angiography of arterial variants at the Circle of Willis

As intracranial MR angiography becomes more widely used and spatial resolution improves, anomalies at the Circle of Willis which have been previously well described on angiographic studies and anatomic dissections will become more frequently appreciated by MR angiography. Recognition of these variants is important to avoid confusion of the anomalies with aneurysms, evaluate collateral pathways in the intracerebral circulation, and enhance pre-operative planning in patients undergoing surgery at the skull base. In this review, we illustrate several of the more common types of anomalies at the Circle of Willis and discuss the possible clinical significance of each.

Authors
Barboriak, DP; Provenzale, JM
MLA Citation
Barboriak, DP, and Provenzale, JM. "Pictorial review: Magnetic resonance angiography of arterial variants at the Circle of Willis." Clinical Radiology 52.6 (1997): 429-436.
Source
scival
Published In
Clinical Radiology
Volume
52
Issue
6
Publish Date
1997
Start Page
429
End Page
436
DOI
10.1016/S0009-9260(97)80003-7

Patients with antiphospholipid antibodies: CT and MR findings of the brain.

OBJECTIVE: The purpose of this study was to determine the spectrum of neuroradiologic findings in patients with antiphospholipid antibodies (APA) and to compare findings in systemic lupus erythematosus (SLE) and non-SLE patients. MATERIALS AND METHODS: We identified 110 patients with APA who underwent CT or MR imaging, of whom 59 (54%) had abnormal studies. Of these 59 patients, abnormalities were categorized as large infarcts, cortical infarcts, lacunar infarcts, hyperintense white matter foci on T2-weighted images, or dural sinus thrombosis. White matter foci were designated as small (< 5mm) or large (> 5 mm). RESULTS: Large infarcts were the most common abnormality, seen in 24 of 110 (22%) patients, followed in frequency by hyperintense white matter foci, seen in 19 of 110 (17%) patients. Ninety-five percent of patients with hyperintense white matter foci had at least one large lesion, and 76% had five or more small foci, three or more large foci, or both. Small cortical infarcts and lacunar infarcts were seen in 11 of 110 (10%) and 10 of 110 (9%) patients, respectively. Dural sinus thrombosis was seen in five patients. The frequency of abnormalities was high in both the SLE (57%) and the non-SLE (41%) groups. Large infarcts were more common in the non-SLE group (26%) than in the SLE group (5%). Although hyperintense white matter foci and cortical infarcts were more common in SLE patients, the differences were not statistically significant. CONCLUSION: Infarcts of various sizes and hyperintense white matter foci are the most common abnormalities seen on CT and MR imaging in patients with APA. We found no significant differences in frequencies of abnormalities seen between non-SLE and SLE patients.

Authors
Provenzale, JM; Barboriak, DP; Allen, NB; Ortel, TL
MLA Citation
Provenzale, JM, Barboriak, DP, Allen, NB, and Ortel, TL. "Patients with antiphospholipid antibodies: CT and MR findings of the brain." AJR Am J Roentgenol 167.6 (December 1996): 1573-1578.
PMID
8956600
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
167
Issue
6
Publish Date
1996
Start Page
1573
End Page
1578
DOI
10.2214/ajr.167.6.8956600

Neuroradiologic findings in fucosidosis, a rare lysosomal storage disease.

Fucosidosis is a rare lysosomal storage disorder with the clinical features of mental retardation, cardiomegaly, dysostosis multiplex, progressive neurologic deterioration, and early death. The neuroradiologic findings in two patients are reported, and include abnormalities within the globus pallidus (both patients) and periventricular white matter (one patient).

Authors
Provenzale, JM; Barboriak, DP; Sims, K
MLA Citation
Provenzale, JM, Barboriak, DP, and Sims, K. "Neuroradiologic findings in fucosidosis, a rare lysosomal storage disease." AJNR Am J Neuroradiol 16.4 Suppl (April 1995): 809-813.
PMID
7611045
Source
pubmed
Published In
American Journal of Neuroradiology
Volume
16
Issue
4 Suppl
Publish Date
1995
Start Page
809
End Page
813

NEURORADIOLOGIC FINDINGS IN FUCOSIDOSIS, A RARE LYSOSOMAL STORAGE DISEASE

Authors
PROVENZALE, JM; BARBORIAK, DP; SIMS, K
MLA Citation
PROVENZALE, JM, BARBORIAK, DP, and SIMS, K. "NEURORADIOLOGIC FINDINGS IN FUCOSIDOSIS, A RARE LYSOSOMAL STORAGE DISEASE." AMERICAN JOURNAL OF NEURORADIOLOGY 16.4 (April 1995): 809-813.
Source
wos-lite
Published In
American Journal of Neuroradiology
Volume
16
Issue
4
Publish Date
1995
Start Page
809
End Page
813

Exercise-related dissection of craniocervical arteries: CT, MR, and angiographic findings.

OBJECTIVE: Our goal was to demonstrate the spectrum of neuroradiologic (CT, MR, and angiographic) findings in craniocervical arterial dissection (CAD) related to exercise or sporting activities and compare the diagnostic utility of CT, MRI, and MR angiography (MRA). MATERIALS AND METHODS: The neuroradiologic examinations of 11 patients with CAD was performed: CT was performed in 10 patients, cranial MRI in 9, cranial and cervical MRA in 4, and contrast angiography in 10. The CT examinations were assessed for the presence of an infarction or a hyperdense artery (consistent with intraluminal thrombus), MRI examinations for the presence of infarction or abnormal periarterial signal, and contrast angiograms for arterial stenosis or occlusion, luminal irregularity, pseudoaneurysm, intimal flap, or distal branch occlusions. RESULTS: Computed tomography demonstrated infarction in four patients. At contrast angiography, a dissection was found in the artery supplying the region of infarction in all cases. A hyperdense artery was found by CT in two patients, which correlated with dissection of the artery or its parent artery on contrast angiography. Cranial MRI findings were seen in six patients (infarction in five, periarterial signal abnormality in five). Dissection was confirmed in all four patients with abnormal periarterial signal who underwent contrast angiography. Two patients with abnormal intracranial periarterial signal had corresponding abnormalities on MRA. False-negative cranial and cervical MRI and MRA studies were performed in one patient because the imaging volumes used for the cervical and intracranial MR examinations did not overlap. Four patients with normal intracranial arterial signal had dissection in the neck demonstrated by contrast angiography. CONCLUSION: Neuroradiologic findings of CAD can include infarction, a hyperdense artery on CT, abnormal periarterial signal on MRI, and a narrowed arterial signal column on MRA. Computed tomography is an insensitive screening examination. Proper use of MRI and MRA involves examination of both the head and the neck with overlapping imaging volumes of the two regions.

Authors
Provenzale, JM; Barboriak, DP; Taveras, JM
MLA Citation
Provenzale, JM, Barboriak, DP, and Taveras, JM. "Exercise-related dissection of craniocervical arteries: CT, MR, and angiographic findings." J Comput Assist Tomogr 19.2 (March 1995): 268-276.
PMID
7890854
Source
pubmed
Published In
Journal of Computer Assisted Tomography
Volume
19
Issue
2
Publish Date
1995
Start Page
268
End Page
276

Neuroradiologic findings in fucosidosis, a rare lysosomal storage disease

Fucosidosis is a rare lysosomal storage disorder with the clinical features of mental retardation, cardiomegaly, dysostosis multiplex, progressive neurologic deterioration, and early death. The neuroradiologic findings in two patients are reported, and include abnormalities within the globus pallidus (both patients) and periventricular white matter (one patient).

Authors
Provenzale, JM; Barboriak, DP; Sims, K
MLA Citation
Provenzale, JM, Barboriak, DP, and Sims, K. "Neuroradiologic findings in fucosidosis, a rare lysosomal storage disease." American Journal of Neuroradiology 16.SUPPL. (1995): 809-813.
Source
scival
Published In
American Journal of Neuroradiology
Volume
16
Issue
SUPPL.
Publish Date
1995
Start Page
809
End Page
813

Lupus-related myelitis: serial MR findings.

PURPOSE: To correlate the MR findings in transverse myelitis secondary to systemic lupus erythematosus with clinical findings during disease exacerbation and remission. METHODS: Four patients (ages 33 to 47 years) with episodes of transverse myelitis secondary to systemic lupus erythematosus were identified. Three patients had recurrent transverse myelitis episodes (one patient with two recurrences), for a total of eight episodes. MR examinations (six after contrast administration) were performed during each transverse myelitis episode, as well as during four periods of remission (in three patients) after therapy with steroids and/or immunosuppressive agents. MR examinations were reviewed for the presence of spinal cord enlargement, intramedullary signal abnormality, and contrast enhancement. RESULTS: Prolongation of T1 or T2 signal (or both) was seen in eight episodes (100%). Spinal cord enlargement was seen in six (75%) of eight transverse myelitis episodes, although it was mild during two episodes. Contrast enhancement was seen in three of six transverse myelitis episodes (dense, inhomogeneous enhancement during two episodes in one patient, and a small focus of enhancement in one patient). During periods of remission, spinal cord diameter returned to normal, and no contrast enhancement was seen, although abnormal signal was present in three examinations performed within 2 months of a transverse myelitis episode. CONCLUSION: Spinal cord widening and signal abnormalities are common MR findings during episodes of transverse myelitis related to systemic lupus erythematosus, and contrast enhancement is less frequently seen. Improvement or resolution of these findings correlates with clinical improvement.

Authors
Provenzale, JM; Barboriak, DP; Gaensler, EH; Robertson, RL; Mercer, B
MLA Citation
Provenzale, JM, Barboriak, DP, Gaensler, EH, Robertson, RL, and Mercer, B. "Lupus-related myelitis: serial MR findings." AJNR Am J Neuroradiol 15.10 (November 1994): 1911-1917.
PMID
7863941
Source
pubmed
Published In
American Journal of Neuroradiology
Volume
15
Issue
10
Publish Date
1994
Start Page
1911
End Page
1917

MR diagnosis of Creutzfeldt-Jakob disease: significance of high signal intensity of the basal ganglia.

OBJECTIVE: Creutzfeldt-Jakob disease is a rare dementing illness that usually affects older adults. Currently, neuroradiologic examinations play a minor role in the diagnosis of Creutzfeldt-Jakob disease. Several single case reports have noted a distinctive finding of hyperintense signal abnormalities in the basal ganglia on T2-weighted MR images of patients with Creutzfeldt-Jakob disease. In order to assess the diagnostic utility of this finding, we studied the imaging features of four patients with Creutzfeldt-Jakob disease in whom this MR finding was present. MATERIALS AND METHODS: Two neuroradiologists retrospectively reviewed the MR images of four patients who had pathologically proved Creutzfeldt-Jakob disease and signal abnormalities in the basal ganglia on T2-weighted MR images. The patients' clinical findings were also analyzed. RESULTS: The four patients had MR examinations between 6 months and 1 year after the onset of symptoms. In all four cases, the hyperintense signal abnormalities in the basal ganglia on T2-weighted images were diffuse and bilaterally symmetric. The T1-weighted images were normal. A CT scan was obtained on a single patient and was normal. CONCLUSION: Although a lack of signal abnormality in the basal ganglia on MR imaging cannot be used to rule out a diagnosis of Creutzfeldt-Jakob disease, our experience and review of published reports suggest that in the proper clinical setting, bilaterally symmetric, diffuse hyperintense abnormalities in the basal ganglia on T2-weighted images may be a specific sign of Creutzfeldt-Jakob disease.

Authors
Barboriak, DP; Provenzale, JM; Boyko, OB
MLA Citation
Barboriak, DP, Provenzale, JM, and Boyko, OB. "MR diagnosis of Creutzfeldt-Jakob disease: significance of high signal intensity of the basal ganglia." AJR Am J Roentgenol 162.1 (January 1994): 137-140.
PMID
8273652
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
162
Issue
1
Publish Date
1994
Start Page
137
End Page
140
DOI
10.2214/ajr.162.1.8273652

Sacral neurofibroma.

Authors
Barboriak, DP; Rivitz, SM; Chew, FS
MLA Citation
Barboriak, DP, Rivitz, SM, and Chew, FS. "Sacral neurofibroma." AJR Am J Roentgenol 159.3 (September 1992): 600-.
PMID
1503033
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
159
Issue
3
Publish Date
1992
Start Page
600
DOI
10.2214/ajr.159.3.1503033

Candidal splenic abscesses

Authors
Chew, FS; Smith, PL; Barboriak, D
MLA Citation
Chew, FS, Smith, PL, and Barboriak, D. "Candidal splenic abscesses." American Journal of Roentgenology 156.3 (1991): 474--.
PMID
1899741
Source
scival
Published In
American Journal of Roentgenology
Volume
156
Issue
3
Publish Date
1991
Start Page
474-
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